Successful implants or skin expansion after radiation??

Adaptecss · February 2015

I am trying to find out if it is standard practice to still try skin expanders and implants, and/or reconstruction when the chest has been radiated!! I have seen research on the high failure rates... My surgeon put expanders in, twice, and failed twice, but she never let on that the odds were stacked against success... Wasted almost 4 years of my life as radiated tissue kept failing to close, so infected, lost expander, healed for 9 months before on surgery list again! Can you let me know what you know or have heard or have experienced? Thanks

BayouBabe · March 2015

Be sure to research fat grafting.

Erica3681 · March 2015

It's my understanding that most plastic surgeons still advise against implants if you've had (or will have) radiation. The failure rate is about fifty percent. I'm not sure that number is totally current, but it's pretty close. Although plastic surgeons have tried various strategies, like fat grafting ahead of tissue expanders to make the radiated skin more receptive, there hasn't been much improvement in the success rate. Some plastic surgeons are willing to give it a try if a woman really wants an implant, and some surgeons have a better success rate than others, but I'm surprised that your surgeon didn't give you a better sense of the failure risk, especially after the first failure.

Flap surgeries do much better with radiated skin, if you're a candidate for those. Also, some women with failed implants decide not to reconstruct and either wear breast forms or go flat. You might find Susan's Story on my BreastFree.org website interesting in that regard.

WinningSoFar · March 2015

I'm in the 50% success category although my breast could not be expanded enough to match the other side, even after the other side was reduced twice. The symmetry though is better than it was, even if I do have to wear a cup on the radiated side. That's definitely better than the heavy prosthesis I had before and which still didn't achieve symmetry.

Erica3681 · March 2015

WinningSoFar,

I'm glad the implant has worked out for you. I just did want to add, though, that not all prostheses (breast forms) are heavy these days. Sometimes fitters will tell you that you need a heavy form to match the weight of the other side. While some weight might be helpful for balance if a woman has a single mastectomy, the breast form can be much lighter than the old-fashioned forms used to be. (Ariom is our resident expert about this. Perhaps she'll weigh in.) Unfortunately, some fitters still go by the old recommendations and some simply don't stock a wide variety of light-weight options.

I often recommend to women who visit BreastFree.org that they check out what's available by visiting online sites like Metro Medical Online or Park Mastectomy Supply, where you can see the vast range of breast forms, both silicone and non-silicone, that are currently available.

Ariom · March 2015

Hi Erica and WinningSsoFar. I am a Uni, and I have found that although I have worn the heavier silicone breast forms without any real problems, I have started to lean toward the lighter forms, which are available now. I was told I had to have the heavier form for my posture, by the fitter, but I have found that the lighter forms, both foam and silicone haven't caused any issues for me and I find them cooler to wear in the Summer too. There does seem to be more of a trend toward the lighter "leisure" forms, for women who have had either Umx or BMX. The sites Erica mentioned have very extensive ranges to look at..

For anyone looking for options about anything Mx related, without reconstruction, breastfree.org is the place to go. Erica has put together an easy to navigate site, which covers so many issues that we are faced with, whether it be choosing clothing, bras or breast forms, there are also photos to give the uninitiated, a good idea of what the surgical outcomes can be.This site was extremely helpful to me when I was weighing up my options before my surgery and I used it as a reference afterward, too.

weety · March 2015

I don't think it is common to use implants after radiation, but I am one who has gotten them successfully. We went very, very slowly with the fills (both the amount and the time in between each fill. I had the expander placed last March 2014, and I just had the exchange surgery last week.

Metta · March 2015

Weety, thank you for weighing in. You have a good p.s.; this NIH study concluded that the slower, the better:

http://www.ncbi.nlm.nih.gov/pubmed/22929235 (22 % failure rate unless the exchange surgery was longer than six months after radiation)

Another study of 94 people found a 20 percent failure rate at two years due to infection after radiation (25 percent at three years): http://www.ncbi.nlm.nih.gov/pubmed/23062707

Here's another NIH study which found that the implant+radiation complication rate is 40%: http://www.ncbi.nlm.nih.gov/pubmed/16462313. It notes that a staged, slow approach is best.

And one more study that recommends fat grafting in addition to a staged, slow process:

http://www.plasticsurgery.org/news/past-press-rele...

Here's a good, honest description of implant-based reconstruction from New Orleans Center for Restorative Breast Surgery:

Careful counseling is important since implant reconstruction differs substantially from the more familiar breast augmentation. The biggest challenge with implant reconstruction is that breast implants were designed to make healthy breasts larger, not to rebuild an entire breast. So they are affected by the same issues that affect any artificial device that is used to replace a part of the body. These devices, whether they are artificial joints, heart valves, or breast implants are subject to wear and failure over time. In the case of breast implants, this usually means a deflation or silicone leak that is addressed with a surgery to replace the implant. Rarely, infections can form around breast implants requiring their removal. Patients should expect the implant to be more palpable than is typical for a routine breast augmentation. Capsular contracture is the most common complication after implant reconstruction and occurs in between 30 and 90+% percent of cases. It is the formation of scar around the implant that makes the breast firm and in worst cases misshapen and painful. Your individual risk is unpredictable except for those who undergo radiation treatments who will nearly all develop it to a significant degree. - See more at: http://www.breastcenter.com/breast-reconstruction-...

I've been doing a ton of research on this because it's the only option for me (besides no reconstruction). I'm not sure I have the temperament to go through multiple surgeries and possible complications. Knowing me, I would not be one of the lucky ones. It's good to know there are some people out there that risked it and are happy now!

clarrn · March 2015

I had expansion, then rads, and exchange on Feb 27th. Unfortunately, I developed cellulitis and yesterday my implant was removed due to extrusion (my infected skin disintegrated). I am still glad I tried, but it is a risk. I have Lymphedema which made it more likely and had infection issues before which is why the surgery was done before the typical 6-12 months post rads. I would encourage anyone to take time after rads even though TEs suck, the longer you wait the better your odds of success.

momwriter · April 2015

Hi,

I had my TE put in before radiation. 2.5 years after that surgery, and 1.75 after radiation, I did my exchange (April 9). The tissue expander did fine after radiation- tho it was big hard and a bit high up. The skin healed pretty well, but. PS did say the skin was a little thin. The PS said it helped that I wanted an implant that smaller than the TE.

I'm now just 5 days past surgery. I know that there is the possibility of failure but I"m hoping it won't. Will let you know. I have kids and am not up for the recovery the bigger surgeries require. So, I'd be really sorry, but I'll probably have to go flat if this one fails.

macb04 · June 2015

Hello, thought I would mention my experiences. Had uni mx July 2012, had TE put under my pectoral muscle. Was going to have a DIEP. Had chemo, and fried to a crisp by rads. Then changed my mind about DIEP when I read about BRAVA and fat grafting. Did that 5 times, 3 with 1 PS, then switched and did 2 more Fat grafting efforts with another PS. In the midst of all those surgeries I had the TE removed, and had 2 horrible infections. Lost most of my grafted fat, had about an Aplus cup. Then got severe radiation fibrosis. Started to get Hyperbaric Oxygen therapy, had a total of 80 visits. Really, really improved my skin. Went from boot leather to almost normal feeling skin. April 9th, 2015 had TE but in OVER my pectoral this time. Worked because new PS thought there was enough fat surviving, thank goodness. I creditthe improvement in my skin to several things. Firstly, fat grafting, lots of studies prove it reverses rad damage to some degree. Secondly was Hyperbaric Oxygen therapy, studies on that too improving oxygenation and skin integrity. I also got IV Vitamin C several times to ward off cellulitis infections, didn't do it enough in the beginning, had initially relied on antibiotics which didn't work. I am also taking Pentoxifylline and vit E daily, which studies also find very useful for reversing rad fibrosis and improving skin health. Sometimes Pentoxifylline bothers women, but luckily it doesn't bother me.

PM me if you want more details. Good luck and hugs for all your hard luck

Tapanga · June 2015

I finished radiation in mid-May and my plastic surgeon won't even think about surgery again until the new year. Wants the skin to heal completely - vitamin E, coconut oil, and anything else I want. She is pushing the lat flap surgery on me because of thinned chest skin, it has much higher success rates. She also has talked about the benefits of fat grafting and is willing to try if I want to go that route. But in the meantime, nothing is going to happen for at least another 6+ months so I happily wear my form and who knows, by that time I might be OK without trying reconstruction again.

clarrn · June 2015

update: 99 days later and my open wound is finally closed!!! Looks atrocious but I am glad to not have dressings. Will see PS again in 6 months to talk about flap options, no more implants for me!

Successful implants or skin expansion after radiation??

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