tissue expanders after radiation

Hi, I had bilateral MX and tissue expanders placed 4 weeks ago. I've had two different breast cancers, a year apart, one in each side. I was treated on right side originally with lumpectomy then rads in 2010. I decided on bilateral MX to reduce risk of either one recurring. My surgeon at first said he prefers to wait 2 years post rads, to let tissue settle before further surgery, as it can affect healing if too soon, however, he agreed to go ahead with MX and TE reconstruction after he examined the state of my skin. I wanted to avoid autologous reconstruction, as I prefer less surgery, less scars and I work in burns and plastic surgery so I see lots of patients with flap reconstructions as part of my work. I wanted the most simple reconstruction with TE then implants. I was filled with 150cc each side in surgery. My surgeon said to wait 6-8 weeks before expanding any more, to let things heal and settle. I saw him this week for a follow up and I'm scheduled for an expansion in 4 weeks. The reason for this is that my right side, which was irradiated is not as soft as my left non-irradiated side. I can tell that the pectoralis muscle is not stretching as easily on my right. My surgeon has told me to massage my skin with lots if vitamin E cream and this should soften everything nicely before I go back for expansion. I know that there is always a risk of failure with tissue expander reconstruction and irradiated areas but I've read other people saying that as long as the expansion is done slowly and left to settle for a few months after the total fill, good results can be achieved. I think if the surgeon is careful then there is less chance of problems. I'm hoping for a good result by being patient.

hows the vitamin E coming along, im going to ask my PS tomorrow what the best thing for stretching the skin is

How does one know they are having capsular contraction, symptoms?

Thanks for the explanation

To prevent CC, I've heard that some PS's recommend taking Claritin or Singulair, of all things.  They are both allergy meds.  I had a BMX with immediate TE placement, then rads.  I waited 7 months and my exchange is Thursday.  ALMOST HERE!!!!  I'll keep you posted.  I'm going to be in the good 50% - no CC!!! 

mariasnow.....holy cow girl!   you sure did get your share of drama didn't you!?!  poor thing!   our situations seem very similar as far as diagnosis and timeframe.......however i had my chemo prior to my dbl mast and then after healing i had my radiation.   i waited 6 months after that and on 1/3 i had a bilateral TE.    still have 2 drains and although they are annoying.....i don't freak out after having to deal with them with the mast.   i, too, worry about lymphedema but so far so good.  i'm hoping it all works out good for me too.  i was scheduled for a lat dorsi and the day before my surgery my PS tells me that i healed so well that she thinks the basic TE should work great.   so now it's just a healing and waiting period.  i can tell the radiated side is harder but not so bad so we'll see how it goes.

i hope things start looking up for you.   i know for me its always sooo much better to be able to talk to people about everything that is troubling me.   getting some sympathy from others and just having someone really listen.   you are going through so much even now......i wish there was a way you could turn down everything around you.   take care of yourself.......and find one of the discussion boards that have supporters to help you talk through everything......these women are phenominal!   God bless you sweety!  

I had 35 rads ended July 2012-no real skin issues, just what looked like a mild sunburn at the very end.  I just had my TE inserted in Nov. and have not had any issues.  

I had a BMX in Oct '11 followed by 6 weeks of radiation. Got through that pretty well and once things settled down, I started to consider reconstruction. Was not willing to cut up good body parts to salvage damaged ones, so that left TE's --> implants.

PS has done two fat transfers over the past 6 months into the radiated side and is happy with the improvement in the skin and tissue. I am scheduled to have the TE's put in on Monday. He plans to fill very slowly over the course of 4-6 months, but is optimistic about getting a good result. My general health is excellent and he feels that is very important.

Not looking forward to another surgery, nor the pain to follow, but I am excited to be moving forward.

Just had mine done on Monday.......If you have any questions, you can email me. I can send you a pic if you want to see how they look. They did a nipple tattoo and skate flap. I don't come on this site often. sheila.barbier@gmail.com Cheer up!! I hear ya......hate being her2+.......it just sucks!!!

Reading your posts are great. I am deciding now on a surgeon Plastics team and one said immed mastectomy with TE's started, expanded then rads and the other said mastectomy, rads, heal then recon with TE's. I am doing neo-adjuvant chemo now FEC x  four (3 week) then Taxol x 8 weekly. I just had my 5th taxol. No big issues with chemo and now not sure which way to go wit rads. I want to nail the cancer but also would like a decent outcome. I am wanting a 36 A or small B cup. I am a 36B now. How long does expansion take for small boobs? and how soon after surgery can they start? or after surgery healing and tissue expansion? I don't know which route to go but need to make that decision soon! Thanks 

Hi Walking IF! Thanks for the reply. My concern is do you think waiting for rads will give the cancer a chance to come back? One surgeon (2nd opinion) told me I should not get immed expanders if I  need rads but I think the surgeon I am choosing will put the expanders in at mastectomy and I will go the route you are. Are you being expanded to a small or large cup size? I was told it would not take long since I want an a or small b cup. Also, how long after surgery did they allow for healing before they started expansion? Gosh , I have so many questions and a bit lost for answers right now.

It's good too know that most are having good results after having the TE placed after bmx and then rads.  I had bmx Aug 12th.  TE place at that time.  I need too finish 3 chemo and then rads.  There is no good answer as which way to go.  TE have been uncomfortable but 4 weeks post op the pain is very minimal and have not taken pain meds in over a week.  Keep telling me good stories.  These are what makes this process more tolerable.  Also can anyone tell me how many cc's were added to get a large B or small C cup?  Would love to have this all done by April. 

I had a BMX 2 years ago & I'm about to have more surgery for a recurrence to my chest wall.  MO thinks my implants will need to come out so I can have a flat chest wall for rads.  I will want implants replaced down the road.  Anyone been through this?  Will I need to start with new TEs? (ugh)  Any tips & advice will be appreciated.

Thanks Jasper.

Jasper I had rads in 2010 and bmx this feb.  Ive spent all year in expanders and lots of pain but am on the home stretch. I have exchange surgery sept 24, only downside with rads is they will need to go smaller to get a better look, but im okay with that considering everything else.  My skin healed great/looks great despite having rads in past.  Ps says i am an unusaul case, but i dont agree.  I took great care of my skin during/after rads and BMX surgery.  Anything you can do health wise will improve your ability to heal and the integrity of the skin.  Good luck to all!  Yes it can be done, i am living proof implants after rads(even older rads).  I did not want diep so this has to work out.:)

Nancy