implant exchange before radiation?

sept45
sept45 Member Posts: 16
edited June 2014 in Breast Reconstruction

I finished chemo 2 weeks ago after a BMX in October. I have TEs as they did not think I would need chemo or radiation but there was one node with a tumor so I am having both. The plan was to have the exchange for implants after chemo and before radiation. I moved in the middle of treatment so I have had two sets of doctors and I thought everyone was on board with this plan. I met with my new radiation oncologist yesterday and she said she was OK with it if I took tamoxifen until radiation.  Evidently she is not OK with it as she told my plastic surgeon that it is not the standard of care.  He has left the decision to me as he says he has to defer to the oncologists as reconstruction is secondary to treating the cancer.  I'm reeling as the surgery is scheduled for 6/24 and I have already planned my whole summer with radiation starting in August.  I'm not sure which thing I am more upset about - a potential change in plans or the fact that my doctor did not discuss this with me at all and had my plastic surgeon call to tell me.  Plus I am once again forced to make a major decision with "standard of care" and "risk of recurrence" being batted around but no real data or anything else to go on. I can delay radiation until August and according to this doc, increase my risk of recurrence but follow my plastic surgeon's recommendations or have radiation first and increase my risk of complications from surgery and have tissue expanders for a minimum of 6 months after radiation.

So my questions:

Have you had exchange surgery before radiation? If so how did it go? What concerns did your doctor have? Was there concern about delaying radiation?

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  • muska
    muska Member Posts: 1,195
    edited June 2014

    I had a hard time deciding what to do first - exchange surgery or radiation. I talked to several specialists and eventually decided to do the exchange first. Oncologists think that the "gap" between last chemo and radiation  should not be long, ideally 6-8 weeks. They think that after 8 weeks, the benefits of radiation start to decline and if you drag it too long it is not helpful any longer. Someone mentioned 12 weeks as the threshold. For this reason MOs are often biased towards having rads first and exchange after. However, when exchange is done after rads the skin often heals poorly even if one waits a few months after rads. 

    In my case, after weighing pros and cons I decided to have exchange first and then radiation. I am a month out of rads and everything is fine so far. 

    Different institutions follow diff approaches. Many do rads first and exchange after, some do exchange first and rads after, and others are flexible and will tailor it to your situation. Good luck!

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  • sept45
    sept45 Member Posts: 16
    edited June 2014

    Thank you for responding so quickly!  How long was the gap between exchange and radiation?  I had really low white cell counts during chemo so last chemo was 5/21 and exchange surgery is scheduled for 6/24.  They said it has to completely heal before radiation but I wasn't sure how long that would be as I have heard 4-6 weeks.  I did heal very quickly from my BMX - at least the skin did so I think I am a good candidate for exchange first.  I'm just reeling as I thought the plan was in place and all of the doctors agreed so far except this one.

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  • muska
    muska Member Posts: 1,195
    edited June 2014

    I think you scheduled it right. My last chemo was jan 16 and exchange surgery - feb 20. Skin usually heals very quickly after exchange especially if the surgeon makes no adjustments and only replaces the expanders w permanent implants. I had some problems with scheduling radiation sooner because they were overloaded with patients so I had to take the start date they gave me. Could have started a week earlier. The scar after exchange was well healed after 3 weeks, so 4 weeks is safe - of course if there are no complications. Check the dates in my profile.

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  • sept45
    sept45 Member Posts: 16
    edited June 2014

    Thanks so much!!!  I filled in the rest of my profile and it looks like our cancer and treatment are pretty similar. I saw my medical oncologist today and told him I was not comfortable with the way the radiation oncologist handled this whole situation and wanted a referral to someone else. He smiled so I think he shared the same opinion. We talked about my diagnosis etc. and he does not think that 4 weeks is going to make much difference, especially considering how aggressive my treatment plan is compared to the kind of cancer I have. He also does not think I need tamoxifen until after radiation. I'm guessing he agreed to prescribe it as a compromise with the RO, not because he thought I needed it. So I have an appointment with a new RO on Tuesday. He is at a great hospital that I already am familiar with and know people who have had radiation there and had great things to say. He is new to the area but the staff at my MO said they are hearing great things about him.  If this works out it is even closer to my house too. If it doesn't my plastic surgeon knows ROs further from me and can give me a recommendation.  I'm OK with having the discussion about which order with an RO and making an informed decision. I'm not OK with an RO basically lying about their opinion and then trying to manipulate the other docs on my team to change my treatment plan without my knowledge or consent.  Fingers crossed for Tuesday!

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