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

Last summer, I had immediate, skin- and nipple-sparing reconstruction (using Mentor MemoryGel implants) following a BMX, and all went well in the healing process. I did not have, or plan to have, radiation therapy. My chemotherapy (CTx4) is complete. However, my breasts are notably lopsided in that one is positioned about an inch or two lower than the other, and the nipples are set at different angles, like broken headlights. The other issue is some rippling on top of the breasts where there isn't enough fat to fill in (I'm pretty thin). So my surgeon and I have been discussing a revision, which I understand is common after immediate reconstruction, to address these issues.

Before making a final decision, I would like to better understand the types and magnitude of the risks involved in surgery to correct there cosmetic issues versus the likelihood of getting better cosmetic results. I would like for my breasts to look more symmetric, but the scars are well healed and not noticeable, I look fine in clothes, and my breasts are not uncomfortable (usually), so I can also live with them as is if it turns out that the risks of additional surgery are higher than I'd like.

Thank you.

Dear Dr Sullivan

I have a back and neck issue and my physical therapist does not want me to have a lat dorsi recon, so I am waiting on a plastic surgeon who says she can do a DIEP BUT I have a large vertical incision from a hysterectomy, and there is nowhere near enough tissue there to create even half a breast shape to match my already reduced remaining breast. An implant is not an option for me so can you fill the rest up with fat transfer? Or is there anything that will strengthen the lat dorsi once some of it has been removed?

Any info would be appreciated as I am very unhappy as I am and have ongoing pain after radiiotherapy three years ago

Thank you

Hi Dr Sullivan

I am 5 years out, DCIS Stage 0 (2.4 mm tumor), treated with lumpectomy, rads.

I went through fat grafting last November. It has helped with aesthetics (I am almost completely flat on my left side). I am slender, so we could only get 80 cc out of my abdomen and inserted into breast.

I lost a few lbs by accident a few weeks ago, and my surgeon was not pleased, as I lost it in my breast as well-- it's still improved, but I lost some of the grafted fat on the inside of my breast.

I asked immediately about implant but he did not want to address-- as I clearly had told him I was not interested in implants earlier.

Have you seen successful implants after rads and lumpectomy?

Thanks

What is your opinion about delayed reconstruction with an implant following standard radiation. I have consulted with a local PS who does a lot of breast reconstruction and he feels it would be a possibility, particularly if we take very slow fills and do not go too big. He does not do fat grafting until the exchange. It has been over three years since rads, and the skin is very soft, but there is no excess skin. I had a unilateral mastectomy. I had implants prior to getting breast cancer and still retain the right one.

Do we really need to replace implants after a number of years if they aren't causing any issues?

I am debating a fourth lumpectomy and radiation which won't be perfect cosmetically I'm told my my surgeon or just going to radiation with the current posterior margin of .5mm or mastectomy. I'm feelong like I want the least invasive procedure without horrible risk. I feel like I can always have a mastectomy if something comes up after radiation.

If I go for a better margin what is likelihood a PS can fix the outcome with fat grafting. What is your perspective! I have ER+ and .5cm of tissue left to my chest wall. All other margins are clear by 10 mm. Thank you

please advice, had a mastectomy and radiation on my right breast for over a year now, my surgeon say I need to do a Dorsi flap due to the radiation I received, so I went for a second opinion because i can not effort to go through another long procedure due to the work I do and financial situation. The second surgeon says he can work with my radiation skin but I am still contemplating which way to go...my TE is still in

Hi JIlly,

I've posted questions here and read others questions but I never see any answers? Do you know what I'm missing? Thank you!

I had 25 rounds of rads following right side mastectomy. I was told to wait 6 months for rads skin to settle before undergoing recon. I was given the option of flap surgery or TEs with implants. My left side will need a lift and implant in order to acheive symmetry. I decided to go with TEs on right side as I felt this to be the least invasive surgery, and my PS was most comfortable with it. I am concerned over success rates with TEs and radiated skin. My radiated skin was initially quite red, but now is just a little more tanned in appearance. The TE was really painful for about a week, and is just now becoming bearable. Guess I am trying to establish if i made the right choice, and what kind of success rates surgeons are having in my situation. That is a TE procedure post mastectomy, and post rads.

I had my reconstructive surgery on May 15, 2015, and a lift on my left breast.  I developed before the reconstructive surgery Red breast syndrome.  My question is this, my left breast that had the lift, is swollen and will be for about 3 months.  My skin is so sensitive and my nipple is super sensitive when something like a fan is turned on at home.  How can I control the sensitivity?  It's driving my crazy, my skin!! 

Onebreast, I think this is just a 'ask your questions' thread for a future blog article. Go over to the reconstruction threads if you would like some answers to your questions.

http://members.boardhost.com/plastic/

For those of you who want your questions answered directly or have more specific issues, you might want to check the above link. It is called Ask The Doctor and it is Dr. Sullivan's associate Dr. Dellacroce. Sometimes it takes him a few days to answer but the board seems pretty quiet lately so you might get a reply quicker.

Hello;

I am thinking about microsurgery t o restore my left mastectomy. I have lymphedma in the left arm, and I have stage 4 bc, inactive. I had a brain tumor. that is gone and removed . I did not have much radiation due to lymphedema. My breast tissue is quite supple and yet I am worried about a DIEP flap becoming infected due-to lymph edema. No return of BC to the breasts. Will I be able to use my left arm, because my right arm and hand are gone due to the brain tumor destroying my hand use. How do they do micro surgery to remove fat from the belly an give you a full breast? Is it safe after being stage 4 recovered for now..Infection is more pressing but after 4 years of a prosthesis I would like a breast. Have you any experience and where are the replies being posted I don't see any from the doctor.

thank you,

Marcia M

mysunshine - if your read the header you will see that this was meant to be an accumulation of questions for the doctor that would be answered in blog post(s).  If you scroll up to the Mods post two above yours and click on the blog link you will see answers.

I have had redness and swelling on my right breast for over two weeks. I had expanders put in 5 months ago after mastectomies, no radiation. My doctor put my in the hospital to get vancomycin for 6 days and the redness seemed to diminish. Since i came home and took oral antibiotics for two weeks, it is still red but has turned a darker reddish purple on the underside. My doctor doesnt think its cellulitis anymore, but he doesnt know what it could be since i havent had fluid buildup at all. And that 4 antibiotics didnt fix it yet. I need some kind of explanation, please, if you have any ideas. Thank you