Anyone do TE to Implants before radiation??

Hey Momof2inME - just a comment. I was expecting to have chemo and my reconstructive surgeon was planning to switch out my expanders before I started radiation down the road. He expressed concern about the skins' ability to heal after radiation and the risk of infection. As it happened at the last minute I was not recommended for chemo so they moved up my radiation and now I have to wait 'till next fall to have my TE's out. I have tried also to figure out what would be optimal. One other thing that I think about is the tightening and firming effect of the radiation on the one side. I wonder if it will relax and even out in time. I wonder if having the exchange surgery after radiation could be a benefit just in case there are any other adjustments that may be called for. IDK. Well anyway have a great day!

Hello,

I was diagnosed with TNBC in April (I'm 31) and had a BMX with TEs, followed by AC/T chemo, and am now starting to think about reconstruction, etc.

I'm halfway through chemo, and my PS has my exchange scheduled for a month after chemo ends, and then I will start radiation a month after that.  I was in a gray zone for rads, but have decided that I need to do everything I can to prevent a recurrence.  My PS is swapping out the TEs for implants before radiation, and he says that we will hope for the best re: capsular contractures, etc.  I would love an update from anyone who has gone through this before, as I know that most PSs swap the TEs out after radiation, and I am VERY nervous about what rads will do to my implant reconstruction. 

Would love to hear from any ladies who have already gone through this!

Thank you.

I don't know if this will help or hinder.  I had chemo,surgery with immediate reconstruct of TE.  Then found out they did not have pristinely clean margins (still microscopic cells at the edge).  I had 2 lymph nodes positive in the axillary as well, so they said - rads.  I had 33 rads with TE in place.  My PS insists on waiting a year after rads are done before considering more work.  Over that year, I did have tightening of the skin around the TE.    I had gone to a PT specialist for myofascial release and deep tissue massage of the TE and radiated area to prep for expansion.  I was 14 months past rads when I went back to start expanding again. The first was fine.  The second was "OMG painful".  The third, was "OMG, I can't breathe painful".  All because of the scarred muscle tissue.  Then the TE on the rad side sprung a leak and the time frame for exchange was rushed.  My rad side would not stay as expanded as the other side.  7 weeks ago I had the exchange.  I was not expecting these results.  I'm sharing the results because I don't give a rip if some pervy man wants to look at my reconstructed and burnt breast.  I'm showing YOU so you can see.  Before my exchange I went nuts trying to find someone who had a positive outcome for reconstruction after rads.  I couldn't find anything.  It was either - "I had no problem at all", "I didn't burn", or "I got such a bad infection, they took it out".  So while I have not had the BEST results, I'm showing you what I did have.

This was the day of the exchange before the surgery.  The taping was over the port where saline kept bubbling out.  I have wondered if the rads weakened the TE.  

 

They believed the leak was mostly likely backing out through the port. They didn't bother testing it, as they were removing it. However, MY theory is this. I had just started seeing a chiropractor around this same time. In one of the adjustments to the middle back, the TEs got a big smoosh against the table. It did not hurt. But over the weekend, the tightness and pain coming from the rad muscle diminished and went away. I was between fills, but noted 5 days later that TE was now pushy. So they worked me in to be seen, and agreed it was mushy and shouldn't be. So they refilledd to confirm a leak, I wasn't half way home before I noted the Te was already getting mushier. This fill did NOT hurt. Unlike the previous two. When I told the doctor about the smoosh at the chiropractor's office, he said it's possible that smoosh broke the scar capsule around the TE and was now allowing for expansion. I think the leak had something to do with the smooshing.

Bird's eye view of the radiated skin.  I did not think the skin felt leathery over the TE.  It is obvious discolored though.

This was the condition of the issue expanders after they were removed.  The "deflated" one was on the rads side.  They were mentor textured TEs.

 The first is ONE day post op.  I have no idea why I chose to take the photo from below the girls. Unless it was because at that point I was not supposed to raise my arms at all.  Several days after the surgery I began to run a high fever without pain or increased redness at the time.  I was having rigors (shaking chills) so I called the doc.  I wasn't showing any symptom of infection so they added another course of antibiotic just in case and we kept an eye on it.  My PS has pretty much decided the fever and chills was a reaction to the acute inflammation in this radiated tissue.  The darkness of the suture line is accented by the black marker that he decorated me with.

 

This is what they look like 6 weeks post op, last weekend...

 

The marks are from the wired bra, notice they surround the implant but not on it at all.  The bra cup needed to do this for an implant was HUGE. (DDD/F) These are 800 Mentor smooth.  But you see the radiated breast skin?  Yeah, it's the pits.  The upper side is still swollen, but that gives nice cleavage on that side.   The area under the scar tightened and and raised up.  It is tough and flat across the front around the scar, and the skin feels leathery despite copious amounts of massaging with cocoa butter and Vit. E cream.  I'm able to massage the implant.  The skin and muscle around is pliable.  But that skin just doesn't want to expand and let the implant drop and fluff.  I have a wad of gauze that I push into the bra in front of maxine because she cannot be "pulled" inside a bra cup and she will not project either.  I named it Maxine as in cranky Shoebox card Maxine.  She's cranky and uncooperative. sigh   The other side is Glinda the good, and this one dropped, fluffed and can be pulled into the bra cup.  She fills a C cup bra very nicely.  It has NO cleavage to speak of.    When I do any physical activity that involves pec movement both implants gyrate and wiggle around.  (which is freaky and not pretty at all to watch) Maxine turns bright red and stays that way for up to 48 hours.  So like yesterday I mopped.  I was bright red last night, so today I'm doing work that does not include pushing or pulling.  I'm ironing and folding laundry.

The plan right now is to keep watching the rad skin.  They don't want to do anything while it's still tighening and changing.  They BELIEVE they will be able to change the shape and appearance with fat graphs (which I have plenty to sacrifice for the cause).  Then I want them to bring Glinda up to the same height as Maxine and then narrow the pocket to match Maxine's width.  Doing this adds the missing cleavage to Glinda.

So I don't know if this helps or hinders anyone.  But this was my experience and I have pictorial evidence to share.  

Thanks Momof2.  I did this to help women who come after me.  This is not everyone's experience.  But it is something that CAN happen. 

I am frustrated.  But kind of resigned as well.  I wish my PS would have considered expanding and exchanging before rads, but there's no guarentee it still wouldn't have happened.  I'm going to try the fat graph.  But I can't make the skin and muscle do what it can't do.  So there could also be a lat flap in the future.