Mastectomy and Reconstruction Options after Radiation

NTS

SHORT VERSION:

Who has successfully had implants after having radiation? I had a lumpectomy followed by radiation. I am still planning to have a nipple-sparing bilateral mastectomy with reconstruction very soon. I think I am too thin to have the diep flap, but the ps I saw didn't really discuss other options, other than implants would not be a good idea because of how the skin continues to change and tighten over time from the radiation. Input would be appreiated!

LONG VERSION:

I had neoadjuvant TCHP from June-Oct 2017 with plans to have a nipple-sparing bilateral mastectomy afterwards. I met with a PS around Sept for a consultation. He advised he THOUGHT I had enough to perform a DIEP flap reconstruction. Prior to meeting with him, both my BS and Oncologist had warned me I may be too small for DIEP flap. After meeting with the PS, my husband and I were both weary about the vibe we got from the PS - he said he could do it, but didn't seem uber confident to my husband and I. He didn't discuss any other flap options, but did say if I needed radiation then I wouldn't be a good candidate for implants, as the skin continues to change and harden over time, usually presenting with uneven breasts.

So after the chemo, I had a repeat MRI. It showed I had a less than stellar response to chemo; tumor only shrunk by about 40%. My BS spoke to the Radiation Oncologist and they determined that regardless of what surgery I get, I should get radiation due to (1) tumor size (2) my age of 32 (3) poor response to chemo (4) small amout of tumor in one sentinel node. Because radiation can mess up a reconstructed breast, my BS suggested I get a lumpectomy first then move forward with radiation with plans to have the mastectomy in the future. I was fine with this because I just wanted to get the thing OUT of me asap.

I had the lumpectomy in November, followed by additional surgery two weeks later to clear the margins, then 6 weeks of radiation. I completed that in January. I'm meeting with the BS soon to discuss the mastectomy, but I'm completely lost on what my options really are when it comes to reconstruction. I don't feel confident about the DIEP flap at all. I'm short, weight 97 pounds and wear about a size 0 these days. I'd love to fatten up for it, but I now essentially eat nothing but vegetables, fruits, non-dairy milk and whole grains because I'm scared to eat anything considered inflammatory and I'm exercising more than ever. However, my understanding is that implants won't look good after having had the radiation. I don't want large breasts anyway, I'd be comfortable with an A cup - just enough to have a feminine figure. Any input, suggestions or experience with reconstruction after radiation would be very helpful.

Lula73

You won't know if you have enough tissue on your tummy or from your upper hip/rear or both unless you see a PS that is a microsurgeon that actually does the DIEP flap & SGAP procedures. If you're seeing a PS who does not do those procedures he/she likely will not bring them up and will often tell you you're not a candidate when in reality he's not qualified to evaluate you for those procedures. Many women who have had rads have had DIEP or SGAP and done fine. The docs at NOLA are some of the best in the world at these procedures even on "thinner"' women. They also routinely do the MX and recon in the same surgery, so you go in with breasts and come back out with breasts. I'd schedule a phone consult with them (there is no charge) and see what they have to say. Here's the link to their website:

www.breastcenter.com