Tissue expansion before or after radiotherapy?

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twentyfour
twentyfour Member Posts: 6
edited June 2017 in Breast Reconstruction

Hey ladies,

Last time I posted here I was a BIRADS 5 and terrified of biopsy results... Well, turned out, I was diagnosed with stage II cancer, got a unilateral mastectomy and am waiting to start chemo a week from now. It's been quite a ride so far, but I'm doing fine. Another confirmation that the fear is worse than reality.

My question has to do with the timing of reconstruction. On June 16th I had a unilateral mastectomy with immediate reconstruction, that is, a tissue expander placed on the site of the left breast. As I said I am starting chemo soon and will have radiotherapy down the road--- and because of the latter, my surgeon says he is not going to expand the tissue any further than the 75cc that are in place right now. He says that if he expands now, he would most likely have to deflate it again for radiotherapy, otherwise there might be complications. The biggest bummer is I have to wait 6 months AFTER radiotherapy to even begin the tissue expansion. That adds another 2-3 month wait to get a resemblance of a breast back :(. Plus, from what I've read, radiotherapy to the lymph nodes can cause the skin to become less flexible, and I'm scared THAT would complicate the later expansion and reconstruction...

I'm confused and worried because this doesn't seem to be standard in the US. From what I understand, the whole expansion process is typically done BEFORE radiotherapy, and the final implants are placed AFTER. Correct? Has anybody had their doctor recommend postponing the expansion (not the implants, those must wait, I know) till after radiotherapy? If so, why is this done?

Thanks so much for your help. Stay strong,
V

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Comments

  • Lisey
    Lisey Member Posts: 1,053
    edited July 2016

    Twentyfour, This board is for women choosing not to reconstruct. You'll probably get much better feedback in a different forum.

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  • hanley50
    hanley50 Member Posts: 146
    edited July 2016

    Hi twentyfour - I had UMX with tissue expander on 06/16/16 (I had neoadjuvant chemo.) My PS told me a couple of weeks ago that if I was going to need radiation that he wanted to "hurry up" and expand as much as possible prior to my starting.

    When I had my consult with the RO last week she also said that they would need to be filled as much as possible prior to radiation.

    I'm not sure how this will all work out. My simulation for RADS is next week (08/03/16.) I have 2 fill appointments before this happens (and I am only at 300cc right now with a 500cc expander.) Since they need to be filled as much as possible prior to simulation and tatoo markings I am really scared that my PS is going to rush and I am going to be in even more pain than I already am in (I also am still struggling with ROM.)

    I have searched this same question and it seems like it varies so much from PS to PS.

    I wonder what happens if you have surgery without immediate reconstruction, then RADS, then decide to have reconstruction. I'm asking myself, isn't that kind of like the same thing as not having a filled TE with RADS?

    Hopefully someone with experience in this area will come along for us!

    Hugs!

    Maryann

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  • Jenwith4kids
    Jenwith4kids Member Posts: 635
    edited July 2016

    I had the same experience as Hanley - - we expanded as much as we could prior to rads. I can't remember if he took any out right before rads - I'm thinking we discussed it but my RO was okay so we didn't.... I really don't remember. But I know that I was overfilled on that side - to give my PS more to work with when we did the exchange.

    I'd question your doc - I think filling a radiated breast is not a good idea - - are you sure that's what he said? Maybe get a second opinion.

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  • Outfield
    Outfield Member Posts: 1,109
    edited July 2016

    I know it's probably unintentional, but I think it's disrespectful to post about reconstruction in a forum for women who have chosen not to do it.

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  • OAJ2013
    OAJ2013 Member Posts: 85
    edited July 2016

    Lisey and Outfield, this forum is titled Breast Reconstruction. How would this be an inappropriate topic on this forum

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  • pab
    pab Member Posts: 53
    edited July 2016

    I did not have my TEs filled very much prior to radiation. I'm not sure the ccs buy I was maybe a small B cup of that. (Felt like I was 12 again!) anyway my PS didn't start filling until about 3 months post rads. And yes rads does mess with your skin-a lot. Thru all of this I had in my mind I was going to have implants. After radiation my PS said she wanted to do the lat flap on my radiated side. I said no and I wanted to try the implants first so she agreed. I had my exchange July 6th. They are not even but resemble boobs now. Still quite a bit of swelling in right-rad side.Softer than the awful TEs! I go for follow up tomorrow (actually it's today already!) I can update after.

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  • muska
    muska Member Posts: 1,195
    edited July 2016

    Hi twentyfour, the timing of reconstruction is a serious question and should be discussed with your entire team in advance, so keep talking to them. I am not sure where you are but on the US East coast they do it in a variety of ways and there is no one answer that fits everybody. I started the same way you started, i.e. had tissue expanders put in during mastectomy, then had the expanders filled in while I was undergoing chemo. At the beginning my PS was open to doing the exchange for permanent implants before or after radiation. RO was willing to radiate with either the expander or the implants in. I had a minor infection at the peak of chemo that was successfully treated with oral antibiotic, but after that episode my PS started insisting on having the exchange done before radiation. They routinely do it in this order at Sloan Kettering center in New York and in some other facilities too. The important thing was to time it so radiation is not delayed by the exchange surgery after chemo (they need to wait for 4 or 5 weeks after last chemo to do the exchange.) I was able to time it well enough and am pretty happy with the outcome. If I waited to do the exchange after rads it would have taken me about another year to finish the process and the healing would be complicated (radiated tissues do not heal well.)

    In your case, I think the healing etc should be easier because of your age. My recommendation is, seek a second opinion from another plastic surgeon and keep talking to the entire team of doctors so that they all agree to whatever decision you make.

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  • twentyfour
    twentyfour Member Posts: 6
    edited June 2017

    Thanks ladies for all your thoughtful replies. I hadn't realized you all had responded and it was lovely to read you.

    They do this differently everywhere... in my clinic, which is the best cancer-treatment clinic in Latin America, apparently, they deflate before radiation so as not to compromise that treatment. It does complicate the recon, but priorities, I guess? (maybe it has something to do with the radiation technology they use, I don't know).

    I had read about the possibility of having the exchange before Rx.. that would have been amazing, but it doesn't seem to be an option here.

    In the end what happened is I got CC on the radiated side, and last week they switched the old TE for a new one, which is now filled up to 350cc.

    So it took an extra surgery and more time, but I'm hoping everything goes well now.

    Thanks and sorry if this was the wrong forum-- as I understood the title "discuss timing and various procedures and techniques" it was precisely the right one. No offense intended.

    Hugs!

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