Reconstruction for irradiated breast

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JoniB
JoniB Member Posts: 346
edited June 2016 in Breast Reconstruction

I was just diagnosed with a second breast cancer 8 years after my first. I had lumpectomy and radiation then. This time I guess it will be a mastectomy but wanted to know what my options are for reconstruction since I had the radiation. I am a thin person. What have others done? Is it possible to have immediate reconstruction in my situation?

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  • BethL
    BethL Member Posts: 286
    edited January 2016

    I'm sorry you're dealing with this beast a second time. I know everyone is different but wanted to tell you my story. I had a lumpectomy and radiation 10 years ago and was redial nosed last August. I did have partial radiation tgen, but according to my ps that didn't change the reconstruction plan. I had a bmx dec. 4th with expanders placed at the same time. I had only 120cc placed during surgery because of my tight skin and prior radiation. Waited 6 weeks for my first fill of 100ccs which was a week ago. Tge plan is to do them once a month. So far, knock on wood, so good. If you decide on a mastectomy, make sure to see a plastic surgeon first if you can to see what your options are. Seems options are better than when you had your first diagnosis. I was surprised, thought I knew a lot, but lots of advances thankfully.

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  • Trvler
    Trvler Member Posts: 3,159
    edited February 2016

    I had a BMX, recon (DIEP) and rads after. My doctor doesn't mind doing it but his colleague wasn't so keen on doing it that way. I wonder what would have happened had I met with Dr. Dr. first. Anyway, here is a great resource to help you:

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

    Dr. D was my second surgeon. So far I am doing fine. I am having Stage 2 in April.

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  • Trvler
    Trvler Member Posts: 3,159
    edited February 2016

    I reread your post and you may not want to have a DIEP since you are thin. I think usually you have to go with implants if you don't have enough tissue. I still think Ask the Doctor can help you.

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  • nash
    nash Member Posts: 2,600
    edited February 2016

    I was in the exact same boat as you last year, except I was 7 years out, not 8. Also thin. My surgeon only offered lat flap with an implant as an option. I supposed I could have gone elsewhere and done DIEP or SGAP, but I wasn't up for it. I was told anything other than a flap surgery wasn't going to work. Since having the lat flap done, I have been in constant discomfort (iron bra syndrome, back spasms, and pulling on the back scar). However, many women are happy with lat flap surgery. I probably would have had similar problems no matter what reconstruction I had chosen.

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  • SmartassSmurf
    SmartassSmurf Member Posts: 157
    edited February 2016

    I had a bit of a different situation. I had tried a lumpectomy, but they could not get clear margins, so when I had my mastectomy after chemo, my PS said he did not want to do any immediate reconstruction. He wanted me to wait until after radiation to do anything because I was only 3 weeks out from chemo when I had my mastectomy, and they wanted me in radiation within a month of surgery.

    So, initially he told me that I would have to do a flap on the radiated side. I waited my 6 months after radiation, and went back in to see him. I asked him to please try without a flap, and after examining me he agreed. His only caveat was that I would likely have to remain smaller than my original size. At the time of expander placement, the TEs had 100 cc. I went in weekly for 30 cc on each side. It was painful. I had to reduce to 15 per side to keep them even, but I kept going. He told me I probably would only get to 350 cc total, but I made it to 450 cc.

    I waited 3 months & had my exchange in December. Immediate relief. I am smaller than I was... but happy I was able to not have a flap.

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  • ALH49
    ALH49 Member Posts: 17
    edited June 2016

    SmartassSmurf -- I'm wondering how you are doing now with your implants. I already went through chemo and BMX with nipple and skin-sparing implant reconstruction (and a second re-excision because of close margins by my pec muscle) , but now two radiation oncologists are recommending radiation as well. Surgeons are saying it's not necessary, but because some cancer was found near my pec muscle (which was clean at re-excision) radiation oncologists are saying they'd like to radiate the rest of the pec muscle to be sure there are no stray cells.

    I'm concerned about the risk-reward of radiation at this stage of the game. Long-term radiation damage aside, I've heard horror stories about what radiation does to your silicone implants and skin, and I don't have enough body fat for a DIEP or probably any other body part either. What has been your experience since February?

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