Radiation after DIEP Reconstruction?

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polamom
polamom Member Posts: 81
edited June 2014 in Radiation Therapy - Before, During, and After

I met with my radiation oncologist today and he seemed a little concerned about administering radiation to my diep reconstruction.   He said it is easier to administer radiation to a flat chest wall.   He warned me it could shrink it and make the breast harder, there can be permanent 'suntan' and  there could be vascular changes like veins showing etc.  And there is a possibility it could damage the grafted veins of the flap.  

 I know he was giving me all the worst outcomes, so I was wondering if any of you have had radiation after your reconstruction and how things went for you.  He will be trying to primarily radiate the chest wall, he thought.   He wants to talk with the doctors who did the surgery about margins and such.

 I know it is just 'cosmetic' and surviving cancer is the bigger picture, but I would just like to hear from some who have been through this 'backwards' kind of way I seem to be going. 

I have to add.  Dr Dellacroce in New Orleans did my surgery.  The radiation doctor lifted the gown on my reconstruction side, frowned a bit (maybe thinking...is this the right side?) and then lifted the gown on the other side and went...."Wowww"    LOL Tickled me to death!   The nurse said, "How's that a mastectomy?"   He later said that's the best job he'd ever seen.   I'm all smiles about that part! Not often a post breast feeding two kids mom gets a wow form a stranger. lol 

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  • KatheW
    KatheW Member Posts: 94
    edited February 2011

    I am interested your topic, and also wondering about intraoperative radiation therapy and brachytherapy.  These radiation techniques are very focused and so limit damage to the flap and surrounding tissue. Does anyone have experience with either?

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  • fof2010
    fof2010 Member Posts: 4
    edited February 2011

    I'm also facing the same situation of radiation after reconstruction.  I had a latissmus dorsi reconstruction and am now in the process of getting many consults about radiation therapy.  So far, the radiation oncologists are not agreeing because I seem to be what they call a "borderline or gray area" case.  I have been told that the lat. dorsi reconstruction holds up better in radiation, but I am still unsure of the whole issue.

    I am too concerned about implant encapsulation and lymphedema but my survival comes first.  If anyone has had radiation after reconstruction that can help, I would love to hear from you.

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  • dlb823
    dlb823 Member Posts: 9,430
    edited February 2011

    polamon ~ I think maybe I'd look for another rad onc.  It seems like the one you saw has given you an awful lot of worst case scenario outcomes, none of which happened to me.  I have a unilateral Diep, which my PS (UCLA) encouraged me to have because it was believed at the time I would need rads.  What I did run into is a bit of a difference of opinion that was quickly resolved as to whether my PS should do Stage II prior to rads (encouraged by rad onc), or after.  But my PS knew exactly what he was doing by wanting to do Stage II after rads (which is what we did) in case there were any issues caused by rads that he would have to address.  But no one ever gave me the kind of laundry list of problems your rad onc almost seems to be implying will happen.  So I'd definitely get a 2nd opinion and try to find someone who can assure you that, while some of those things could happen, mostly likely they won't.  Good luck!  And nice to hear the compliments re. your work.  I've had those remarks too, which make me realize that a lot of docs (oncs, rad oncs) haven't even seen Diep recon., which makes me wonder about how up-to-date other areas of their practice are.    Deanna

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  • fof2010
    fof2010 Member Posts: 4
    edited February 2011

    I am not super informed about the DIEP reconstruction so if my question is stupid, I apologize.

    Did you have rads with an implant in your breast, or was that put in place after rads?  I am not sure if this is what you mean by Stage II. 

    Also, we have a somewhat similar diagnosis (stage/grade/small tumor/small number of nodes involved).  I am considered a "borderline" case for rads.  Why did your dr. assume you would need rads?

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  • imatthew
    imatthew Member Posts: 206
    edited February 2011

    hi, my wife had DIEP at the same time as her unilateral mastectomy.  We knew before surgery that based on tumor size and location there was a very low chance of radiation.  The post-mastectomy path report came back with good margins, and the only 1 of 4 nodes had anything, so the primary surgeon told her that radiation wasn't necessary.

    However, during our discussions with her plastic surgeon we asked him about the impact on DIEP if it turned out that she did in fact need radiation.  He said that it wouldn't have been a problem and that the only real impact would have been that she would have had to have waited at least a year after radiation for stage 2.  I've read a whole bunch of posts from others and I've seen both "surgeons prefer radiation after DIEP" to "surgeons prefer to wait until after radiation to perform DIEP", it seems to be entirely subjective based on the view of the individual plastic surgeon.  

    see my questions/responses here: http://community.breastcancer.org/forum/70/topic/757778?page=1#idx_8 

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