Does immediate breast reconstruction affect radiation?

rbpv

Hi All, I'm scheduled to have next week a mastectomy of my left breast. I wasn't recommended the immediate reconstruction due to the high risk of needing radiation to my chest wall. I'm still not 100% sure if opting for having the silicone implant after the radiation is the right decision, since my plastic surgeon is completely in favor of the immediate reconstruction but not the radiation oncologist or my surgeon oncologist. Wondering if any of you who went through immediate reconstruction with silicone implant and radiation after had any problems on the quality of your radiation treatment and, of course, if that impacted the overall success of your cancer treatment. Also interested in hearing from who opted for having radiation first then the silicone after how did it go? Thanks in advance!

Runrcrb

I’ll reply with my experience although I did not reconstruct with implants.

I had a tissue expanded placed at mastectomy. I then had chemo and radiation. None of my doctors suggested implants prior to radiation.

Post radiation my breast tissue was fairly scarred - not quite hard to my touch but to the experienced touch of the breast surgeons it was hard/damaged. I do think my breast looked very different (not in a good way) after radiation.

I waited almost 9 months before I had flap reconstruction. My plastic surgeon did remove some breast skin due to radiation damage.

All doctors were against implant or flap prior to radiation due to damage risk to the implant/flap

Brenaj

I had reconstruction after radiation. I had a double mastectomy and was reconstructing both side. On the non-cancer side, I had no complications. On the cancer side, I handled radiation very well and I had tissue expanders placed (on both sides) about 4 months after I finished radiation. I filled 100ccs at a time (for total fill of 800ccs on each) side. When I went in for my last fill, the radiation/cancer side showed signs of infection. We tried to save the expander and I was fast tracked to replacement surgery, but we eventually had to pull the expander from the radiation/cancer side. After the radiation/cancer side healed, my plastic surgeon, who stated, when we pulled the expander, that I would have to have the procedure when they use muscle from the back of your shoulder (the name escapes me), stated I had recovered so well, that we could do fat grafting on the radiation/cancer side instead. The fat grafting worked miracles, it healed the radiation damage and 3 months later I was able to have another expander put in. All my fills went well and I am done with fills on that side and scheduled for exchange surgery in mid-May (waiting that long due to work commitments). We don't expect any issues. In hindsight, had we done fat grafting first, I don't think I would have had infection problems etc. and would not have had to have the expander pulled and then replaced.

Moderators

Hi rbpv, and welcome to Breastcancer.org!

Thanks for joining and posting -- as you can already see, our Community is chock-full of really helpful members, always willing to weigh in with their thoughts and experience.

You're sure to receive some more great replies here soon, but in the meantime, you may want to check out the main Breastcancer.org site's page on Implant Reconstruction Risks for more information.

We hope this helps!

--The Mods

Young36

hi, I'm not sure if this is what you were looking for…

I was diagnosed in January 2017 and was treated at Sunnybrook Toronto. I had a right mastectomy with immediate reconstruction (diep flap) in March (one surgery). Then chemo May to August and 25 rounds of Radiation in November 2017.

Like you, The medical oncologist and the radiation oncologist and the surgical oncologist were not in favour of the reconstruction. But it wasn't their body... it was mine.

I am a DD36 and I wanted to keep the other healthy breast so the plastic surgeon recommended the diep flap using my tummy fat. I'm young (36) and this was a once in a lifetime surgery and I wasn't worried about the recovery. I was warned about the radiation changing the results...

Would I do it again? Yes. It was a nine hour surgery, but I went to sleep with a breast and woke up with basically a breast without a nipple. It was larger than the healthy breast to account for radiation shrinkage. Did radiation wreck it? No. In fact it just shrunk it up, smoothed it round, and made it a better match to the size of the other one.

At almost a year later....

The pros: I can wear any shirt, I look normal in a bathing suit, it is warm to the touch and I am getting used to it more more every day. My tummy is wash board flat.

The cons:

The whole right side of my chest is totally numb...collar bone to bottom of the breast mound and half way around my ribs on the side. It will never get feeling back again. A Large band in the middle my tummy is also totally numb. No feeling what so ever.(Whatever it can't be perfect) ....

Bra shopping is impossible... the new breast is very firm, the chest wall and ribs are tender...no wires....no push ups...no padding. This is hard to describe... but the new breast will remember padding that is not completely smooth for an hour after you take your bra off...kinda like An edema dent. I am trying to be kind to her. She is loving the Ta Ta Tamer bra at lululemon.

The doctors who were not thrilled about the reconstruction have all said that my reconstruction has “had an excellent result

rbpv

Runrcr: Thanks so much for sharing your experience. It was good for me to have an idea in terms of healing time of the skin after radiation and also to know what were your doctors recommendations.

rbpv

Brenaj: Thanks very much for sharing your experience and I hope all goes well with your exchange surgery.

rbpv

Young36: Thanks so much for sharing your story. In my case I only qualify for a silicone implant. I'm aware that the radiation can impact the results of the implant, but my plastic surgeon still says it's easier to fix the radiation problems to the implanted breast, than a reconstruction in a flat radiatiated area. The conflict between my doctors is that the radiologist says that the immediate reconstruction can also affect the quality of radiation, but my plastic surgeon says that the implant will have no impact at all in the radiation. That's is the part that worries me, since I want to be sure that having the implant will still allow to have the best treatment for my cancer as possible.

Young36

It sounds like they have a good plan for you. If it helps, my radiological oncologist assured me that the reconstruction would not compromise the radiation treatment. I remember she laughed at me when I asked if it would. Then she went on to say “it will pass right through everything” even a part of my right lung..... it is strange the things you find reassuring.

Remember each step is progress and there is newlight on the other side.

Wishing you a safe surgery and a comfortable recovery.

miranda2060

i had immediate silicone implant reconstruction, and am now one-third the way through six weeks of radiation. The implant was urged over the DIEP because it was anticipated I might need radiation (as it turned out, I had a positive margin) and radiation was considered prudent.

I had been extremely concerned about the impact of the radiation on the implant, based on things I had read. After talking with the radiation oncologist (not terribly reassuring on the issue) and the plastic surgeon (wonderful person), I am reassured that any problems that occur can be fixed. The implant feels heavy and hard during the week when I am having the radiation treatments, more pliant during the weekend. PS says it's due to the skin swelling, and will subside. The implant is still making its way downward to where it will eventually settle. It will take months.

I have no concerns about the radiation being less effective because of the implant.

Wishing you a smooth recovery!