implant reconstruction still possible after radiation?

Thank you! Glad to know that fat & tissue grafting after radiation can help to get implant. I'll definitely ask my Plastic Surgeon on the next appointment. I'll check whippetmom's thread.

I'm not HER2+. I have one + for HER2 expression. There needs 3 + signs, high expression to be considered HER2 positive. So I'm classified as Triple Negative. I updated my signature to clarify it.

I am treated at MD Andrrson, the medical center campus. I have talked to my PS again, he said it again he would not perform implants based reconstruction after radiation, because failure rate is so high, such as infection, or implant poking out :-(

Glad to hear that you waited for 7 months and had a successful surgery! I'll see another plastic surgeon tomorrow, and I'll ask her if she can do it if I wait long enough

Hi ladies, I have decided not to get radiation therapy. Here are some updates from the past one month:

1. My radiation oncologist presented my case among his co-workers who specialize in breast cancer radiation therapy. 2 oppose radiation, 1 abstains, and 3 others favor radiation. The doctors here have a split view toward my case. Opinions range from strong oppose to strongly favor.

2. Regarding whether or not the tumor once invaded into my pectoralis muscle or the skin, my radiation oncologist asked an outstanding diagnostic radiation oncologist to read all my imaging from the beginning to the end. The conclusion is that the tumor never grew into the muscle, nor the tissue in front of the muscle, nor the skin. It's fair to stage me as T2N0. So the worry that the tumor was once in my chest wall and skin is dismissed.

3. I had a good talk with my medical oncologist on Sep 18. The results of a test I urged her to do after surgery coming back. The repeated biomarker status test on my residual tumor indicated I'm ER+ now. Even though the stains is only 15%, but 5% mark puts people into ER+ territory. I'm hence qualified for hormonal therapy. My medical oncologist is not sure tamoxifen will work for me, 'cause a typical ER+ patient has 70-80% positive stains. But she think I should give it a try. Tamoxifen works very well to lower the recurrence rate. If indeed I'm ER+, tamoxifen will greatly benefit me.

4. I searched online and read a research paper published by a radiation oncologists at Memorial Sloan Kettering. The local recurrence rate is about 5.4% for T2N0 Triple Negative patients. I hence flew over to New York City, and went to seek a second opinion from her on Sep 21. She agrees with me that removing back muscle is an invasive surgery. She said if she was in my shoe, she wouldn't do radiation. According to her, my local recurrence risk is below 10%. Radiation can cut that half into 4-5%, but the chance will never be 1% or 0% even after radiation. She doesn't think it's worthwhile to do radiation in my case, given the reconstruction complication. In fact, she said if I asked anyone of them at MSKCC, they wouldn't give radiation treatment to patients who are T2N0 and have no LVI identified, unless the patients themselves are very anxious to do so. Years ago, there's even a radiation oncologist at MSKCC did a study arguing that T3N0 patients who doesn't have LVI (of course no lymph node involved in the first place) do NOT need radiation. She thinks my own immune system has a good chance of fighting off the cancer cells, if any, left at my original tumor site, since I have had the tumor for nearly a year and half but my lymph nodes are all negative, which indicates my immune system might be fairly robust. And the 8mm margin is a decent margin. For mastectomy, they usually look for a margin larger than 5mm. 8mm is enough. She also explained to me more about the research paper published by her. The age factor doesn't pop up for TNBC. Whether I'm 30, 40 or 50, it doesn't matter much. It may matter for other types of breast cancer, but not for TNBC. She also suggests me to take tamoxifen. In fact, tamoxifen is regularly given to breast cancer patients even if they have low or none ER stains at MSKCC.

5. I went to see another plastic surgeon on Sep 28. She was once one of the best plastic surgeons at MDA, and went into a private practice. She confirmed that the possibility of implant based reconstruction after radiation was very low. She personally wouldn't operate on me if I had radiation. She would definitely push me to use donor site tissues and skins. I was hoping for a robot assisted LD flap surgery if I in deed undergo LD flap. That type of surgery is pioneered at MD Anderson in recent years, which leaves no scars on the back. However, she warned me that the nipple might shift position to move up higher on the chest after radiation. If that happens, the skin at the back has to be sacrificed to make a football shaped patch in the breast, hence a robot assisted muscle-only harvesting surgery is not feasible anymore.

6. I consulted another medical oncologist in a different institute. She is the sister of a friend of mine. She thinks radiation would be considered super aggressive treatment for my case, and she wouldn't do it if it were her.

With all of above information, I have decided not to get radiation therapy. I feel I made a informed decision. I won't regret it even if anything happens in the future. I have done enough for myself. Ladies, please wish me good luck with it!

Kelly, thanks for sharing with me your experience! Good to know your case is so similar to mine! Now I know one more TNBC sister. I wish you a good reconstruction results next June. They sure will find ways to help you get rid of the concaved breast and restore a new one. I hear you on the DIEP flap. I agree it's probably less invasive than the LD flap. I feel different doctors have different preference of what type of reconstructions they will choose. My PS at MDA shakes his head on DIEP flap, favor robot assisted LD flap. But the other PS I saw who left for private practice favors DIEP flap. Well, one could argue that the first PS is not good at DIEP flap, and he is among the only two doctors at MDA who have the privileged training to do robot assisted LD flap, hence he opposes DIEP flap; and the 2nd surgeon isn't able to perform robot assisted LD flap, that's why she favors DIEP flap. My point is when it is time for you to do reconstruction next year, just make sure you interview at least two PS and get the one who's most skilled at DIE flap if that's the surgery type you favor. It's important to be in the right hands.

MinusTwo, thank you! If wish you the best of your treatment too!

Hugs,

Kristi