Implant surgery after radiation

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Runmommy
Runmommy Member Posts: 13
edited March 2018 in Breast Reconstruction

Hello all,

Looking for some input as I need to make a decision soon on changing my current left textured implant for a smooth one.

I had a mastectomy and reconstruction on the left side several years ago, and then last year had a mastectomy and tissue expander placed on the right side. I also had proton radiation on both left and right last year after having the surgery. Now I'm about to have the right tissue expander exchanged for a smooth implant, and have been given the option to remove my left implant (which is textured) and replace it with a smooth, due to the ALCL risk.

I'm not being pressured to replace the left implant, but have been combing the literature and speaking with a surgeon who has seen a few cases of ALCL, and I understand that the prevalence of this is probably slightly higher than has been reported. I also know that the risk of complications and problems from replacing the implant after radiation are not insignificant either -- but I've had great luck with surgery and radiation recovery, and terrible luck with cancer (no risk factors that I can tell, but have had BC twice...) so I'm concerned that I could have some predisposition to cancer or immune issues that we're not yet aware of.

My questions are, has anyone had experience with implant surgery after radiation? How did the healing process go? Any longer term outcomes that were not what you expected? Or anything that went well?

Thanks so much for any input!

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  • Gussy
    Gussy Member Posts: 115
    edited March 2018

    I saw a plastic surgeon last week prior to having lumpectomy/partial mastectomy yesterday. The PS was not encouraging re: having an implant after radiation. She said that the skin and tissues change which not conducive to implants. And if the defect wasn't too large she might be able to do some fat grafting to fill in and then reduce the other breast to match. I wasn't thrilled. The defect looks fairly large to me now but it's early yet.


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  • OCDAmy
    OCDAmy Member Posts: 873
    edited March 2018

    I completed rads at the end of January and am now waiting to see if I will be able to get implants. My skin is healing well and my expanders held up. My PS suggested DIEP or LD procedures that use your own tissue but a big surgery like that scares me. I am hoping we can move forward with the implants and fat grafting. I won't be getting the switch from expanders until June.

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  • Runmommy
    Runmommy Member Posts: 13
    edited March 2018

    No ideal answers for any of us! With regards to implants, my surgeon also does the expansion before radiation, and the exchange at least 6 months after radiation. Seems to think that stretching the tissue before radiation works out better, but of course still a high risk for having issues. I'm still optimistic given that my skin held up well to radiation. Amy, I'm not an expert by any means, but barring any other risk factors or problems, I would think that implants could still be considered for you despite having had radiation, especially since you've already been expanded... I know it's still a bit of a controversy, but at the large cancer center that I go to this practice is not unusual at all.

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