Implant reconstruction after post mastectomy radiation

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Allydp
Allydp Member Posts: 520
edited June 2014 in Breast Reconstruction

I'm having a BMX in August followed by radiation. Since I'm not a candidate for the flap, it's been recommended I have TE's placed at time of BMX, followed by rads, fills and finally the exchange. My BS and RO have acknowledged the increased risks rads has on reconstruction, but both feel confident in this plan. I have my first consult with my PS this Monday. I plan to ask about fat grafting, as I've read this can be helpful on the radiated breast. 

Has anyone gone this route of reconstruction after post mastectomy radiation? Did you have complications? Are you happy with the result? Are there any particular questions I should as my PS this Monday? 

Thanks! 

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited May 2014

    I did not require rads but have also had repeated surgeries related to skin healing issues.  I have seen a number of people who do this process in reverse - do the BMX/TE surgery, fill through chemo and immediately afterward, so that you are fully expanded by the time you are ready to start rads so that skin has already stretched. Some even fill the rads side with more saline to compensate for the potential contraction and shrinkage, so that you can achieve symmetry at exchange. Stretching radiated skin is problematic, but not impossible.  The problem is that it is hard to predict in advance who will do well with it and who wont.  It can depend on how your skin tolerates rads, but if you run into problems then it is too late to re-invent that wheel.  You might pose this scenario to your team and see what they think.  As far as fat-grafting you have to have a PS who understands this process and has done it a lot.

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  • Nanam
    Nanam Member Posts: 21
    edited May 2014

    I had the same reconstruction as you are planning.  The TE placed at time of mastectomy and radiation done after fills completed and exchange for implant after that.  I'm pretty much finished now and happy with the results.  I just had the fat grafting and nipple reconstruction done last month.  The fat grafting really improved the tightness of the scar tissue that had developed as well as filling in areas that needed it.  I may have to have more done. The only complication I had was a seroma that developed after exchange and leaked through the incision requiring the implant to be replaced.  The whole process took much longer than I expected so patience is required!  Good luck. 

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  • BayouBabe
    BayouBabe Member Posts: 2,221
    edited May 2014

    I also had my reconstruction this way.  I was overfilled on the rads side to allow for shrinkage from rads.  This meant I had to fill extremely fast, muscle relaxers were my friend!  I then had fat grafting done at time of exchange.  I just had a revision surgery last week with a second round of fat grafting.  I am VERY pleased with my results.  I, thus far, have been problem free.  Be sure to find a PS that will do the fat grafting and has experience with rads girls.  I am positive this has been the reason for my reconstruction success.  I am a fellow Michigander, but on Lake Michigan side!  Good luck!

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  • Allydp
    Allydp Member Posts: 520
    edited May 2014

    Thank you SO much, ladies! You have all been very helpful! I think I was mistaken on the timeline. You are right in that they will fill prior to rads. So BMX/TE's, fills, rads, exchange. 

    What are your thoughts on fat grafting and recurrence? I've read a couple of articles saying the jury is still out whether or not it increases the risk. If this were the case, wouldn't the DIEP flap also pose a risk? It's the same tissue, right? I don't know what to think about all that.  

    BayouBabe, hello fellow Michigander! I'm so glad you're pleased with your results. Can I ask the name of your PS? It would be a drive for me, but just having a backup in my pocket might come in handy. My consult is with Dr. Izenberg out of St. Joe's in Ann Arbor. He's supposedly the recon guy, so we'll see. If he doesn't have a ton of experience with rads and fat grafting, I will continue my search. 

    Thanks so much again. It's nice to know that, despite the risks of rads, there are still success stories out there. 

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  • BayouBabe
    BayouBabe Member Posts: 2,221
    edited May 2014

    Allydp - I do not worry about it increasing the risk of recurrance.  I agree, in my mind it is no different than a flap.  Cells are cells.  But I understand some people's fear of increased risk.  My doctor is Dr. Dennis Hammond in Grand Rapids.  Very happy with him!  Awesome bedside manner, very compassionate, and great surgical skills!  Good luck!  Wishing you the best for surgery, rads and reconstruction!

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