Radiating Expanders, Chance of Implant "failure"

Hi Springtime,

I had an expander put in when I had my mast. My expander was filled during chemo so it was fully expanded when I did rads. I didn't have any problems with the expander during rads.

I can't answer #2. I know there are women who have successful recon with implants after rads but I was told upfront by my ps that implants usually did not work when you had rads.

Have you already been told that you'll have rads? I know rads is a given when you have a lumpectomy. But if your nodes were negative and you have a mast I wouldn't have thought you'd have to do rads.

The cosmetic angle didn't factor into my decision to do bilat. I had ILC that didn't show up on my mammo. It wasn't until I found a lump and had an ultra sound that my bc was found. After that I just didn't trust a mammo to find cancer if it popped up on the other side. I also knew that I wanted to do tissue recon and since DIEP can only be done once I didn't want to take a chance on needing recon again. I didn't know about the GAP procedures at the time.

Since you're just starting chemo you have time to research your options. Immediate recon with skin sparing mast will give you the best aesthetic results with minimal scarring whether it's implant or flap recon.

Good luck to you with everything.

Springtime,

I deleted my last post because it didn't copy/paste well but I can't find the link that Beesie provided on another thread, to post instead. Anyway I'll try the copy/paste again.

Here is the deal-- 

Big picture- almost 100% of implants will have some degree of capsular contracture after they (or the expanders before them) are irradiated. Not all will be terrible or immediate. It may not show up for years, may be mild enough to live with, can be dealt with in revisions, etc...  I believe the 50-60% figure relates to the amount of CC which is bad enough to be considered a "failure" within a certain window of time. It is complicated and it is tough to get a straight answer.

Anyway- there are still people (myself included) who have immediate reconstruction using implants even though radiation is recommended. Most of us didn't know we would need rads until an SNB was done during our mastectomies. At that point, the plan was already in place. The PS team goes ahead with the mutual understanding that this isn't a perfect situation. 

Rarely will expanders/implants be placed when the Plastic Surgeon knows IN ADVANCE that rads will be recommended. Generally, though not always, such patients are guided toward delayed recon.

If expanders are placed, there are 2 ways different surgeons like to move forward. Some will irradiate the expander, others will do the exchange about 4 weeks prior to radiation and irradiate the implant. To my understanding, neither is "better" so far as eventual CC is concerned. It is just a matter of preference at different institutions. 

I have an implant with rads.

If your PS prefers to irradiate an expander, there are a couple of different methods. Some will partially deflate one or both expanders to get a better line in rads. I have never heard of the expander being REMOVED, just deflated.

Sometimes this is deflation is done in a process called "immediate-delayed reconstruction" popularized by MD Anderson. In this case, the idea is that the pocket created by the expander will have cosmetic benefit in a TRAM or other flap procedure post-rads. You'd have the benefit of a skin sparring mastectomy and some additional tissue for the PS to work with, regardless of whether you choose to do an exchange for an implant or a TRAM flap. Does that make sense?

Bottom line is that you have an understanding that it is PROBABLE that implant reconstruction will have some degree of cosmetic problems. That said, there are some benefits to moving forward. If it works and the CC isn't too bad, great. If it doesn't work and you need the TRAM, you'll have some advantages over someone who never had an expander.

You don't burn any bridges moving forward, it is just an issue of comfort, expense, etc. 

Hope this helps.

Stephanie 

Hi springtime,

I had a left mastectomy 10/06 with expander put in. I knew that i was going to need radiation but i chose to go with the implant anyway. I didn't do any fills until 6 months after radiation was done. My ps warned me about failure with radiated skin but i wanted to try the least invasive procedure. I had the exchange surgery in5/08 and a reduction and lift on my right side. My incision would not heal so i just had a tram flap on8/7/08 and so far so good. I guess i should have taken my ps advice but at least i tried and now know that the implnat did not work out for me. Good luck. 

I went through the whole expander process a few months ago - was completely expanded and waiting for the final implant surgery when something went terribly wrong.  I started leaking fluid, my temp went to 108 and my body went into septic shock.  I was in the hospital for several days and in a lot of pain.  That was a couple of months ago and I am pretty much recovered.  I knew there was a higher risk of problems after mastectomy with radiation but I decided to try it anyway.  Wish I had just gone ahead with the tram flap to begin with.  I am planning on scheduling that surgery in the next few months.

Jennbtwins, congrats on your first post! We know there are many, many helpful members on these boards, but since this thread was last posted on in 2008, you may not be reaching them. We'd suggest starting a new thread (and you can copy and paste the post you just made), in the Breast Reconstruction forum, but clicking the link, and then clicking "Start a New Topic", where you can paste the post and click Submit.

We hope this helps!

--The Mods

I wish I could get my expanders before rads but the first plastic surgeon I saw advised to have rads before and I am wondering if anyone else had the radiation before the TE and if so how long did you have to wait before you got the tissue expanders after the radiation was complete

Stephanie gave a very good explanation above. They can radiate with expanders or with permanent sylicone implants. In both cases, there will be some impact to cosmetic appearance. I ended up in a rather typical situation when I went into surgery - BMX with immediate reconstruction - expecting I would not need any follow-up treatment at all (based on tumor size and clean MRI.) I woke up with expanders and was notified I had multiple lymph nodes with macro mets, so would need chemo and rads. I had the expanders filled while I was having chemo. I consulted several professionals in different institutions about what to do: radiate with expanders and do exchange surgery after radiation, or the other way around. Eventually, decided on having the exchange surgery first, and then radiate with permanent implants in. Main reasons: (1) it simply does not heal well in most cases if exchange is done after radiation, (2) it takes much longer to complete the process b/c one would need a long wait after rads to even attempt to do exchange surgery, (3) some scannings, e.g. MRI cannot be done while you have expanders in.

You can see the dates in my profile below. I recently had follow-ups with my team and they all said that the way I look is very typical: radiated breast is slightly smaller and slightly perkier than the other one. That is absolutely not noticeable when I am wearing a bras and I wear fitted clothes a lot. Feel free to PM me if you have any other questions.

I just noticed that the original post is very old, my apology for not taking that into account.

Thank you very much for your response. Did you gave to wait the full three months after rads to get your TE.

I did not have bad burns or oozing or peeling, I was just pretty red. That radness went away rather quickly and the skin remained tanned for maybe about 8 months slowly paling down. By the 9 or 10 month it was normal color. No corrections or grafts were needed.

My PS told me to do a light massage on the radiated side every day, so my morning routine consists of 1) shower, 2) apply good natural moisturizer to the radiated breast only, and 3) do a quick massage of the radiated breast only. I have been doing that since the completion of rads and the skin looks excellent.