IMPLANTS AFTER RADIATION?

I had implants before BC.  When I was given options for treatment I was shocked that they started with UMX as the treatment.  My lump was tiny.  They did mention the UMX being skin sparing with an implant.  My husband and I were in shock.  We thought it would be a tiny lumpectomy and then radiation.  The end.  Well, when we asked about that option they explained the risks of radiated skin and using an implant.  For me, astetically, the UMX was the best choice.  The PS then met with me and suggested using the latissimus muscle to support the implant.  He also explained in great detail (same as julianna51 listed) what can happen to an implant due to radiation.  He didn't recommend it.  I had my UMX/lat surgery in October and one revision in April.  I haven't had any problems with the lat surgery.

I have read of other's experiences with recon after radiation and it sounds like there are more issues but I have read about those with no problems too.  As suggessted, do a search and see what the experience has been.

It's still up to you and everyone is different.  You have to find the best solution for you.  One that you can manage and live with.  Good luck.   

I also had failed recon after a lumpectomy and rads.  Never was I told about the long term effects of radiation, and, at the time of my diagnosis, I didn't know to consider the aesthetic outcome that continues to deteriorate from the rads over time.  I have met with dr. Massey while she was in chicago and am considering a completion mastectomy and DIEP per her recommendation.  Whatever I decide, I would highly recommend her to anyone, and also, in a perfect world, would shout from the rooftops that radiation causes long term damage and that should be a HUGE factor when making a decision about treatment.  Of course it would help if the diagnosis itself wasn't so shocking and paralyzing to the point that a lot of us women just do what our surgeons say.  It is one of my biggest regrets and I have made it my committment to counsel any newly diagnosed women to get as many opinions and as much info as possible, even during a very scary time.

I'm surprised with all the legal stuff you have to sign before surgery ..that similiar waivers aren't required before radiation/lumpectomy?  (But then again - who actually reads all that fine print).

I had a BMX and no radiation...My PS's office is very thorough with overdosing you on information ...I remember clearly some of the wording in the documents I had to sign before surgery.  They even went as far as to write that "I may not be able to breast feed after this procedure".  Really? 

I feel compelled to comment on the other side of the radiation picture.  Prior to my BM, it was my understanding that those that had radiation could not have the one-step procedure or implants. I had radiation in '96.  When I was diagnosed with DCIS in 2011 (BRCA1), my breast surgeon referred me to a plastic surgeon who was know for taking on challenging cases.  I did my due diligence, checked out information within my informal area cancer network, online, etc. and moved forward. This was the reconstruction I wanted for many reasons.

After my initial evaluation / examination with the PS, he thought my skin was in good condition and it was a go.

I had my BM via the one-step procedure in Nov 1011.  My radiated breast behaved differently and had an infection and needed a scar tissue release revision. The PS and his staff were amazingly proactive when dealing with it - saw me more often then I ever expected and I never doubted for a second they would make it work.  I can't remember when the last time I've felt so cared for in my life.

Net - I believe there is a vast difference in the PS out there - if you've had radiation - talk to a number of PS and find one that has a successful track record in dealing w/ radiated breast reconstruction and have them assess the condition of your skin.  Having physical therapy is also essential. There are many women who previously had radiation who've successfully had implant reconstruction.

Good luck -   

http://www.hopkinsbreastcenter.org/services/ask_expert/viewquestions.asp?id=999808342

This is a question and response on the topic from the Johns Hopkins Hospital "ask the expert"  web site (Of course there are other microvascular free flap options besides DIEP.)

It's me Singingsparrow from Cincinnati.  Just processing all of your wonderful input and comments. (refer to my story above) I failed to mention I'm a twice breast cancer survivor. First time in 2001 and second time late 2009. I had a lumpectomy, chemotherapy and 6 weeks of radiation in 2001. In late 2009 had BMX with immediate reconstruction. So even 8 years out the first time my skin and tissue on the radiated side never did heal properly when the tissue expander was placed.  I wanted to add that I heard one PS explain "plastic surgery is taking a part of the body that is relatively normal in appearance and making it look better. Where as reconstructive surgery is more medical and taking a damaged area whether by surgery or accident and attempting to reconstruct to a normal appearance". That is where my first PS failed, he was trying to fit me in his world of cosmetic plastic surgery and I was left out there on my own attempting to get answers as to why this was happening to my skin and tissue. In the end it was a lose/lose situation for both of us. He should of referred me to a more skilled surgeon who has or can deal with radiated skin. In return he has recieved bad reviews through my family and friends who saw what had happened to me.

And ladies, if you read the fine print on implants I believe you need either a mammogram or other test every year to check for leakage otherwise the warranty is nullified. And the extended warranty only covers the cost of implant only, not the surgery, hospital, anesthesia and loss of income fees.  Please forgive me if I don't have the information exactly correct, I'm going by total recall but I'm fairly sure most is correct. I know of at least two women where they had implant leakage. The old adage 'don't think it will happen to you' doesn't always apply.

And in attempt to get 'closer' I requested all my medical records. Wow, what an eye opener with all the fine print and did I really sign that many? A resounding yes. A friend asked me "would I go through the whole experience again for two million dollars?" I hesitated and just could not say yes to that question. Nope, not even two million dollars would cover the cost of the pain and suffering of a failed reconstructive surgery.  Now 2 1/2 years later I wish I had the DIEP or some other skin grafting procedure first.  I just thank God that the DIEP was available right here in Cincinnati. The University Hospital is so much more medical focused and treated me like a patient with medical needs...which essentially all of us breast cancer survivors are.  Take care ladies....I'm finally ready to have my nipple tattoos soon.

There is a new procedure that I am interested in.  Fat injections are used for several months or so before they put the implant in.  I am hoping this will become more available soon.

I agree that all BS should have to inform us of all options available.  That did not happen to me.  I was rushed into an lumpectomy and 7 weeks of rads actually stretched to 8 because of the holidays.  To later find out I was at high risk for local recurrence and would have to have scans every 6 months for life.  What kind of roller coaster ride is that?  Not one I wanted to ride.  I found out at the end of rads that if I had had a MX I would not have had to have radiation.  I was pissed.  At my one year follow up they found another lump so surgery again.  Thankfully this time was B9 but I said no more.  I saw 3 PS before I decided on the one I was to use.  I used Dr. Ledoux with PRMA in San Antonio and all 6 doctors there do nothing but breast reconstruction.  I had a BMX and went with TE's.  I am too thin for DIEP flap.  Even though I had some skin issues during rads my skinned actually healed pretty well but he did say that did not mean the tissue under the skin was in good shape.  He is a micro-vascular surgeon so his big concern was blood flood to my tissue.  Because of the previous rads he did not want a BS doing the BMX and wanted to do it himself so he could salvage what he could of my blood vessels.  Since I was not dealing with active cancer at the time and did not need another SNB he was able to do this for me.  He also was able to save my nipple on my rads breast which I am thrilled with.  I am still in my expansion process and so far everything as gone well.  He is expanding me slowly every 4 weeks. He went over high risk of failure with TE's following rads but felt it was worth trying on me and if it failed we could do another type of flap procedure as long as I understood the risk which I did.  He also said I was not the first one like me he had done and he had never had a failure, not that I could not be his first but he would do everything he could to make it successfully. My BMX was March 26th and I will probably have my exchange the end of August. I know that even though the TE part has gone smoothly I could still have capsular contracture after permant implants are placed.  If I had know all the long term SE from rads I would never have agreed to it.

Lizdehart,

Here is a link to one article.  I think this is very exciting!

http://www.healthcanal.com/cosmetic-surgery/25995-Combination-fat-grafting-and-implants-shows-promising-results-initial-study.html

I finished rads last january and had implants put in april, didn't work out, incision opened and it had to come out, had expander put in and was to start over, woke up one morning to a big hole , was only expanded once so my only option was a tram flap, had that last november and it looks fine.  i do think if i had waiting longer after finishing rads maybe the implant would have worked out, but who knows.  from what i have read on this site, most wait at least 6 months after finishing rads, i only waited 4, maybe longer is better for skin to heal, maybe it doesn't matter.  My ps did tell me the risk of rads, but 3 different rad docs suggested getting it so I did, i wanted to do everything possible to prevent it from coming back.    hope this helps.

MrsMot I think waiting a year after rads is a good thing.  give your body time to heal and makes the chances of the next surgeries more successfull.