Reconstruction after RADIATION

Patricia, Thank you for starting this thread.



My bs left a lot of skin. I am really hoping my ps will schedule my TE's after I see him next month. That means it will be a month after getting done with rads. I started aquafor before rads and even though I am done, still apply twice a day. Drink lots of water!!!!!! I am sure it helps with elasticity.



Kestrelgurl, wow that was a long process. Glad your happy. What is inside the gummy implant???



Gentle hugs

a lot of rad women have natural reconstruction.  There are some surgeons in Miami who do DIEP and you might want to look into the Breast Reconstruction center in Charleston SC.  There is a thread here called Charleson Bound.  I had DIEP on my left side 4 years ago and am having SGAP on my right due to a recurrence and radiation.  Latissmus dorsi flaps are also very common after radiation but I was not willing to sacrifice my muscel/

I took 3 weeks off work after my TE surgery and only one week after exchange. I work in a running store, so not sitting at a desk.

I had radiation then had bilateral DIEP. DIEP is a muscle sparing natural flap reconstruction using abdominal tissue, veins and arteries and moving to the breast area. You can read about all the flap procedures as well as others at my PS website. Dr Massey in Charleston. www.drmarga.com

Like Kestrelgurl, I intend to use fat grafting to my radiated side BEFORE putting in TE's.  I had a skin sparing BMX and finished radiation September 2012.  I've been using prothesis since that time.  My first fat grafting session is scheduled for the end of August.  My PS indicated he intends to do a couple of fat grafting sessions, and is targeting a total of 200cc's of fat in each side.  I'm 5'4", 135 pounds, so don't have enough fat for a DIEP.  I was fairly busty before (34DD), so have extra skin on both sides to work with.  I'm hoping for something in the range of a 34C when all is said and done. 

This is a relatively new procedure, and there's no empirical evidence out there yet that suggests this procedure works over the long-haul....just anecdotal like Kestregurl.  However, I've decided I'm willing to be a guineau pig if it ultimately results in being able to avoid a more invasive surgery. 

Raelan-I am confused, if you had the skin sparing why would you have to have fat grafted. My ps is going to place tissue expanders in me and then the exchange.

My surgeon is doing fat grafting at the same time as my exchange surgery. Possibly more at a later date as well when I have my nipple procedure. However, my skin held up very well during radiation. I also had expanders in at time of radiation. My radiated side was filled 70 ccs over the other side - just in case of any tightening during/after radiation.

Another surgeon I consulted with wanted to do fat grafting as well, but months before the actual exchange surgery. I want to get these TE out ASAP; hope I am making the right choice.



Originally, I was not expected to have radiation, but due to small margins, that plan changed quickly. Thus, they filled my TEs VERY quickly. Not a pleasant experience! From my research, there are so many different ideas out there on the proper way to proceed with radiated skin - but it is a definite possibility! Go to several plastic surgeons and don't give up until you find one you are comfortable with and who has experience with radiated tissue. They are out there! Best of luck to you during radiation. Find some aloe vera gel and use it several times a day - I think this is what helped my skin come out the way it did.

i wanted to weigh in on the discussion on FT for helping radiated breasts accept an implant.  My friend had this done (wish i had gone this route).  From my understanding this is not a straight fat graft like you would get if you were just filling in after reconstruction.  The procedure harvests stem cells from the fat removed and they inject a greater portion of fat plus stem cells into the radiated breast.  I can tell you at the hospital where my friend had it done, 50 women have undergone the procedure and none have rejected the implant (although the follow up is not that long).  They encouraged her to stay at a B cup to make extra sure the implant would be ok.  She is on the expander part and doing fine.

Raelan, did you have skin problems with the radiated side?



I was just so thrilled that my 2nd opinion said he could do it, te then exchange. He did say however, the smaller I go the better the outcome.

Ok, I am set for this Thursday to have expanders placed. My radiated side looks really good.



April 1st mastectomy

April 22nd thyroidectomy

July 12th hysterectomy

July 25th expanders



Almost done ladies!!!!!!!!

Patricia--you are using all of the right stuff for your skin BUT there's nothing you can do about the effect on your pectoral muscle and chest wall.  I had radiation in March/April 2012, and while my skin is fine and very usable per the PS, my pectoral muscle is so tight on that side that I have to stretch it almost daily.  I have not had any recon yet, and I can't imagine putting a tissue expander and then an implant behind the pectoral muscle on that side.  It's really bothering me today.  I do not have the same tightness on my prophylactic side.  I'm sure it's due to radiation unfortunately.

I had mastectomy a couple weeks ago and am starting radiation (25 tx) soon.  The margin was positive for the tumor closest to my chest wall and that tumor was the most aggressive one of the four (pliomorphic), which is why I am having radiation. (Can't get proper margin without taking muscle.  The fascia of the muscle was taken during mastectomy.)

The PS told me I need to lower my BMI to 30 to 32 before consideration for reconstruction.  Therefore, I need to lose 90 pounds, which will be a challenge but a benefit to my health for sure.  I am (was) quite busty and now look very funny being concave on one side and still busty on the other, so I am hoping for reconstruction.  Inserts float high on me while my busty side pulls way down in my soft bras.  That is even funnier looking than concave/busty combo.  

Here is the tough part.  The radiation oncologist told me that the PS wrote in his notes: No reconstruction.  I wonder if that is because it is only his current recommendation or whether the fact that I cannot have anything from my belly taken as I had hysterectomy (uterine cancer) last fall or because I am in my mid sixties.  I will clarify with him, but I really had the feeling that for some reason he did not like me.  (And people tend to like me from the get go.)

So, have any of you had single mastectomy, been busty, older and overweight and eventually had reconstruction?  I am wondering if I am plumb out of luck.

Thanks.  This has been quite a journey and I wish I had found you all earlier!

HollyBoo

I am seriously thinking about this.  Why do you suggest before radiation?  I will do that if the PS's opinion might affect the radiation tx!

Thanks for your quick response!