Ask plastic surgeon Scott Sullivan, M.D., your recon questions!

Is it possible to successfully correct or improve mild to moderate encapsulation to a radiated implant? Thank you Dr Sullivan

I need help deciding what type of recon to have. I am planning to do double mastectomy with immediate recon. I will then have radiation. I don't want the reconstruction to interfere with the radiation, but I also don't want to delay radiation.

Would DIEP surgery prohibit or delay the radiation? What about the expanders? (I prefer the DIEP or SIEP but not sure there's a PS here (southeast GA) that can do it.)

Thank u so much!!

If one develops Capsular Contracture, will they always be high risk for it or can it be avoided during subsequent surgeries ?

I'm considering fat grafting to help flatten out my concave areas after a failed TUG flap reconstruction. I've talked to my PS about taking some fat from the little pouches that have formed just in front of my underarm area since my BMX. My concern is does doing lipo in that area disturb the lymph vessels and put me at a higher risk for lymphedema? Thank you!

I had a lumpectomy and then radiation. Due to an abscessed seroma my breast was opened up again (a second incision) and that wound was left open to drain. I now have a 1 cm deep and 2 cm long hole on the outside of my breast, right behind the lumpectomy scar, it is not going to heal anymore, it's done. When the seroma was drained by nipple turned outward as well. Can this be fixed-the hole filled. Is plastic surgery doable with a radiated breast ? I don't want an implant, just a patch job and maybe scar removal of some sort.

Where is a good place to gather statistical information on the failure and complication rates on different types of surgery?

Where can you gather accurate statistical information on particular plastic surgeons, including the types of surgery, complication rate, and failure rate?

I have moderate encapsulation and severe axillary cording and am 2 years out from completing rads. I had implants (bi-lateral) placed immediately before radiation. I have significant discomfort and have significant loss of symmetry. The tightness has led to shoulder motion limitations (and resulted in a torn labrum which was repaired). I have completed several rounds of infrared laser and myofacial release therapy with modest success. I have a thin build (around 18 BMI). My PS proposes a lat flap on the radiated side. I am very reluctant to do this as I am very active and enjoy activities such as kayaking (which is impacted but still possible in my current state). Are there other solutions? And can the axillary cording be cut during revision to relieve that pain? Specifically, is it possible to consider a combination of a smaller implant and fat grafting to introduce some healthy tissue to the area? Thank you for your time.

Hi Solacetea, I would definitely consult a PS vs. a general breast surgeon. A PS typically has more of an aesthetic focus. Also, they may be aware of some additional options for you. For example, I've got the same situation as you due to a failed reconstruction - loose skin, extra flaps, etc. I'm having surgery in 2 weeks to remove the excess skin. At the same time, my PS is going to do some fat grafting to fill in the upper area where I am very concave. Perhaps your breast surgeon can make a recommendation of a PS in your area?

When will the blog be written? Will we be notified about it?

Hi Dr. Sullivan

Can I have fat grafting while on Herceptin? I had a BMX in 2003 for DCIS, and had a smal IDC in 2013 followed by chemo and radiation.

I would like to have fat grafting but am reading that this is not an option while on Herceptin.

thanks in advance, Sue

great question Momine

Dear Dr Sullivan,

I have silicone implants ( pre cancer). I had one implant removed, lumpectomy and then replaced followed by rads. I have annual mammograms. Just found several lumps in the axilla area of my 'good boob'. They are painless but do move. Several small lumps in good boob. Could this be a ruptured implant

jojo9999 has a GREAT question … Most PS's, and from what i've gathered is "standard practice", overfill TE's to accommodate the implant with a little extra skin for softens and a more natural look. If I read it correctly, Jojo is suggesting that some PS's actually under-fill to accommodate the needed snug fit of an anatomical. This is actually the first I've heard this and am curious to know if this is true and recommended. My ps had not done many anatomicals but I was confident in his ability …… that is, until it came down to actually deciding and he seemed very unsure of what size implant to use (in all cases, suggesting something smaller than where my TE's were filled), but I was greatly concerned with whether or not we would have a snug enough fit. The Mentor rep happened to be in his office that day and we asked him and he essentially told us there isn't a "standard" but there was a chart that illustrated, based on fill volume and skin area (chest wall, etc), which of their available implants would work. And, along similar lines, are there special TE's designed for an exchange to an anatomical implant?

Q:  Fatty Tissue Necrosis: I would like to know the incidence of this occurrence as well as risk facotrs contributing to the development. 

I have completed (in this order): chemo, bilateral mastecomy with immediate tissue expander placement, radiation, bilateral exchange with cohesive gel implants aka gummy implants, nipple reconstruction and will be having 3D areola tattoo soon. I have not had any fat grafting; plastic surgeon has recommended but I have declined due to the risk of fatty necrosis and not wanting to go through further testing(s) to confirm.   I would like to make an informed decision on this issue.