Pre-pec reconstruction after radiation. Surgeon reccomendations?

N830

I have been having a heck of a time finding a plastic surgeon that's willing to do prepec reconstruction for me because the area was irradiated. I've had subpec expanders in for 1.5 years now, been referred to multiple plastic surgeons only to be turned away due to the radiation. This process has taken months per surgeon, and I'm quite tired of having the expanders in. As far as I can tell, this surgery is possible and has been done before, so I'm wondering if anyone here has had this done, with favorable results, and is willing to recommend a surgeon? Same question for those who've rad radiation and later had subpec implants revised to prepec. I'm in Colorado, but at this point I'd be willing to travel within the US.

RatherBeSailing

Have the plastic surgeons who turned you down examined you, or do they not do pre-pec after radiation as a rule?

The reason I ask is that everyone’s skin reacts differently to radiation. So even though it has been done before for some women it may not be a viable option for you.

FWIW, I had a skin-sparing mastectomy and anticipated that PS would use existing skin in DIEP - it seemed fine to me. But my PS threw it out and used skin from abdomen instea - he said breast skin was too damaged.

Sorry, don’t know any surgeons for this. Hope you can find a solution you’re happy with.

N830

The only PS who examined my skin post radiation commented that it was in great shape when I asked, so I'm working off that assumption. Unfortunately he doesn't do prepec at all. The second said he wouldn't do the surgery on anyone who had done radiation as rule. The third cancelled before I even got to the appointment because he saw I had done radiation. It may end up being the case that there is non-visible damage to the skin but I have yet to get to the point of having it examined.

Lalbo

Do these PS's know of any other surgeons that work on radiated skin? Could they make a recommendation??

If you're willing to go anywhere, The Center for Breast Reconstruction doesn't seem to be hesitant about working on radiated skin. When I talked to them they said they did it all the time. I currently have implants that I want removed and revised to DIEP flap. I have an appointment with Dr. Michael Beckenstein in Birmingham, AL (he has a very good reputation) I want to see what he says before I make a decision on what I am going to have done and with whom. If I go with NOLA, I'll have to save up a lot to cover the out of pocket my insurance doesn't cover.

Lalbo

Update: I went to see Dr. Beckenstein. He was nice, very matter of fact. I like that. Don't try to sell me a bill of goods. He did confirm I had capsular contracture. He asked many questions and kept saying "I wouldn't have done it that way" regarding anything the prior PS did. He prescribed me Singulair to see if that would help ease the CC. It hasn't on the rad side, but the non rad side seems to be more soft which means it is dropping farther down than the rad side. I try not to let it get to me when I see it in the mirror. Dr. B wants to wait until 1 year post rad to do any more surgery. He said I am not a candidate for DIEP flap. I'd beg to differ. lol He said if the rad skin doesn't cooperate he would suggest lat flap. UGH, not really thrilled about that option. I hope after months of being on Singulair the rad side will cooperate. I have a follow up teledoc appt with him 5/24 to see how I'm doing. I think there are a couple of options, but at this point is a waiting game until after 8/26/22. Trying to forgive original PS and move forward, still pisses me off what he did/didn't do. I guess it is good, mentally, to know that nothing will be happening for a while so no need to think or worry about it. At least that's what I tell myself.

star2017

My PS asked to do my reconstruction before radiation; however, he is a fabulous doctor, and it is definitely worth consulting with him if you are willing to travel to DC. His name is Dr. Troy Pittman. He has switched to private practice, but was with a university hospital when I saw him.

https://somenekpittmanmd.com/

RatherBeSailing

For what it's worth - and not saying this is the case for others - my original PS said I didn't have enough belly fat for DIEP. That surgeon did mostly implants, and two other surgeons who specialized in DIEP said they could utilizing both sides of the belly. It is called "stacked" DIEP. A more complicated operation, but worked.