radiation impact on reconstruction options

imatthew · September 2010

imatthew · September 2010

Hi all. My wife is facing a unilateral mastectomy and we're currently looking at immediate DIEP, but we don't know yet if she will need radiation post-surgery. If there is a chance that she'll need rads, then what are our reconstruction options? Can they still do DIEP? Or, would she go the TE / implant route then maybe have DIEP later on?

Thanks!

3monstmama · September 2010

I think you and your wife need to meet with a good plastic surgeon who specializes in reconstruction from breast cancer, not just doing implants.

Some plastic surgeons will not do immediate reconstruction. Some won't do certain kinds of reconstruction if you have had radiation. And the fact that she is considering a mastectomy does not, alas, mean she can escape the zaps.

Your breast surgeon should have some people to refer you too.

Good luck!

imatthew · September 2010

thanks for your comments. We are working with a primary and plastic surgeon who specialize in breast cancer and breast cancer reconstruction (they work together). We did talk with the primary surgeon today and she doesn't feel that radiation is going to be necessary, so we're keeping our fingers crossed.

lago · September 2010

I agree with 3monstmama. You need to meet with at least 2 really good board certified plastic surgeons that do breast reconstruction. There are so many option and all have pros & cons. There are options for those of us that are having radiation. (Still not positive I am).

makingway · September 2010

You might want to look into a new surgery being done in Miami. It is less invasive than DIEP or impants. It truly is the wave of the future. It was invented by Dr. Khouri from the Miami Breast Center. He uses the brava system. Here's the link-it's quite graphic http://www.miamibreastcenter.com/breast-reconstruction/after-mastectomy-miami.html

Radiation is recommended based on whether there is no node involvement and size of the tumor. I think it's recommended if the tumor is over 5.0 cm. Just becuase it's recommended does NOT mean you have to do it. It was recommended to me and I declined to do it.

BTW By The Way-having an axillary lymph node dissection is for 'staging' purposes ONLY. There is no therapeutic value in doing it and can be disabling for life.

jantheun · September 2010

Hi everyone.......I had TE at time of Mastectomy.......tight and uncomfortable from the start........5 months chemo.........30 rads chest wall and axilla.......lots of rad burns to deal with.....saline implant surgery exactly 1 year after TE along with reduction and lift in unaffected breast. 9 months now and the implant is causing me some problems....skin is tight and uncomfortable. PS thinks that maybe extracting 50cc from implant might reduce discomfort......in hindsight, I would not have opted for this surgery......too many what ifs............altho' the other options are more intense/invasive.........I would have chosen them over taking the risk of TE/implant with radiated skin. Everyone is different but research has shown that there is some risk with this procedure. While you have asked to hear the success stories, I have added my experience so you can make a decision which you feel is right for you.........I still have the implant.......considering what to do next.......my friend did not have rads.......had implant success...........we both had the same PS............I would be very cautious in making this decision if rads are part of your wife's treatment.........best to you........

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dlb823 · September 2010

I had Diep recon @ UCLA. Diep was specifically recommended for me over implants partly because they felt I would need rads, which I also had. My PS was very comfortable working on radiated skin that had had time to rebound from the RT, but I know this isn't always the case. I had my Diep with my mast, but then had to wait a couple of months (I actually ended up waiting about 6 mos. at my discretion) to do my Stage II.

Just be sure you understand the experience, limitations and preferences of the plastic surgeon with whom your wife is working.

Good luck! Deanna

Mariposa109 · September 2010

Hi Imatthew,

I have had a lumpectomy and chemo, and now will be having a bi lateral mastectomy. I want to have the immediate DIEP done as well. I spoke with NOLA (www.breastcenter.com) and was told that if I do the DIEP that I can still have the radiation, and that most women do just fine with the flap. OR I have the option of doing the mastectomy and having a TE placed in the breast that will be radiated (the TE would be only slightly inflated I believe) and then waiting 6 months after RT to have the DIEP. I guess it depends on what surgeon she works with what they feel would be best and course of action your wife would rather do. I am currently waiting on Insurance approval to go to NOLA. Best of luck

Texas357 · September 2010

I had 33 radiation treatments with a tissue expander in place. I wanted to try the easy route first, so went with an implant after the radiation was completed. My plastic surgeon assured me that I could always try something else if the implant failed. It turned out that my skin didn't hold up well, and had an LD Flap done about 8 weeks ago. This time, the results seem to be much better.

radiation impact on reconstruction options

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