Delayed reconstruction after radiation

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Nickel103
Nickel103 Member Posts: 42
edited June 2018 in Breast Reconstruction

Hello,

I’m 7 months post radiation and am about to have my tissue expanders replaced with silicone implants next month. I have had some shrinkage on the radiated side so am a little nervous about the outcome - both related to the lack of symmetry and also increased risks due to radiated skin. Anyone have any insight, tips, or advice to share going into this? Thanks!

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  • SCGirl50
    SCGirl50 Member Posts: 43
    edited April 2018

    My PS said there was a 50% failure rate with implants on a radiated breast so I went with flaps instead.

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  • meg2016
    meg2016 Member Posts: 287
    edited April 2018

    I waited almost 12 months between mine. The 50% failure rate on radiated skin isn't accurate and I would be suspicious of a surgeon who said that, (although some surgeons do have higher failure rates than others and its worth asking your surgeon theirs.) Mine were completely lopsided going into exchange, both on size and position. My surgeon was able to fix a lot of that in surgery. She actually was happy for me to wait a little longer than 6 months so things could settle after radiation before the exchange. She ended up putting a larger size of implant on the radiated side. At first it was quite noticeable (to me, not to anyone else) but over time she indicated as radiated tissue contracted this would help the radiation side drop a similar amount as the other side (more weight) and also to not get squeezed smaller by contraction. I am really happy with how they look now about 8 months after my surgery. Your biggest risk is infection, so make sure to follow your surgeon's directions very strictly on minimizing activity and support bras, etc. If you go too hard too fast, you will get inflammation which will increase risks. Even though you will feel pretty good after the exchange and it will be tempting!! You can get great results from implants after radiation for sure!!

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  • Nickel103
    Nickel103 Member Posts: 42
    edited April 2018

    Meg2016: thank you for your honest and hopeful reply! My PS had also mentioned potentially doing a larger implant on the radiated side too. It made me nervous, but your explanation makes sense and is very reassuring. So thank you :) Just curious if you’d share your PS’s opinion on nipple reconstruction after radiation? I’d been hoping for reconstruction prior to tattooing, but my surgeon is hesitant to d it on radiated skin.

    SCGirl: thank you for sharing! My PS told me 20% rate of failure which is still scary! Flaps unfortunately weren’t a real option for me, so I’m going ahead with the implants. Wish me luck!

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  • meg2016
    meg2016 Member Posts: 287
    edited April 2018

    20% is what my surgeon also said is standard, but said she has typically not had that high a failure rate although it depends a lot on the skin quality. I didn't actually discuss details of nipple recon with my PS- she said we could discuss it and she would consider it, but I know it is supposed to be risky on radiated skin. I want the look of nipples but don't care about having the 3D or want another procedure, so I wanted to do 3D nipple tattoos with Vinnie Myers but without doing the physical nipple construction. PS said sounds great, to let her know if I changed my mind. Vinnie Myers team comes to her office, so that makes it even easier.

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  • lg10
    lg10 Member Posts: 71
    edited June 2018

    I wanted to see if anyone else had any experience with the exchange after radiation. I went for a TE fill today and talked to the plastic surgeon a little about how this will change my situation. I had a unilateral mastectomy and planned to do an implant on the "healthy" side as well. Surgeon told me that radiation could make the outcome look a little less desirable since the radiated skin will constrict and the implant could possibly be higher on my chest. I know they will never be perfectly symmetrical and I have realistic expectations, but I felt a little defeated today. I'm not 100% that I will need radiation after I finish chemo (1 lymph node +), but now I am really questioning whether I will do it. I feel like there is a quality of life factor that we all have to live with. I'm only 32 and I am having a hard time with this for some reason! Any advice would be appreciated.

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  • Nickel103
    Nickel103 Member Posts: 42
    edited June 2018

    I think it depends a lot on your surgeon and their skill level. My surgeon is very good but was also very honest about potential complications from radiation. I just had my exchange surgery 2 weeks ago (bilateral) and after radiation. My surgeon was able to break the scar tissue from rads up really well, which I think makes a difference. It’s definitely still a bit tighter on the radiated side, but they look pretty symmetrical without a bra, and more so with one. My surgeon did mention he considered using a large implant on the radiated side as another poster mentioned above. I would ask if they might consider that for you. I would also ask about using alloderm or fat grafting, as I’ve heard both can improve the integrity of radiated skin. My biggest gripe is that the surgeon is very hesitant to do nipple reconstruction after radiation, so you should ask about yours about that too if you’re interested.

    I’m sorry to hear of your woes. My diagnosis is very similar to yours at age 34. Hope you’re managing okay. Being young I’m finding the hormone therapy effects to be especially challenging.

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  • lg10
    lg10 Member Posts: 71
    edited June 2018

    Thank you for your response, Nickel103. I'm glad you are happy with the exchange. That gives me hope! I have a lot of faith in my plastic surgeon and I know he will do everything possible to make this work for me. Sometimes I think I should have just gone with the bilateral to make things easier during the exchange, but that's the choice I made at the time and now I have to move forward and not look back. Did you overfill your radiated side? If so, how did you deal with that in clothes? The nurse said she was going to make me very large on the mx side. I'm naturally a 34B. So that may be a challenge for a few months.

    We talked a little about the nipple reconstruction today and he feels the same as yours. I think a tattoo may be the best bet.

    I'm sorry to hear about the hormone therapy. I am also very nervous to start that. Are you on Tamoxifen? I've been in chemoland the past few months and I think it's been such a routine that I have forgotten about exchanges, radiation, hormones, etc. I feel like it's not something we should be dealing with in our 30s. How did you handle radiation in general?

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  • Nickel103
    Nickel103 Member Posts: 42
    edited June 2018

    I was very worried about having had radiation leading up to the exchange surgery, but now it seems like much less of an issue than I expected. I hope it will be the same for you! Since I did bilateral they over-filled both sides. It was crazy uncomfortable. I actually had to have my non affected side deflated for a while (it was in the radiation field and they needed to get it out of the way), so I was quite uneven for a while. I wound up taking some of those removable pads that come in bras or bikinis and stacking 2 or 3 over my smaller breast in the bra to help even them out. Never expected to be stuffing my bra at 34, but there I was.

    Chemoland is for sure something that sucks you in. Radiation was much easier. I did start to get really tired towards the end, but it’s a month and you’ll get through it okay. I feel like I bounced back to pretty normal after a week. I wound up having one little small patch of skin that took forever to heal. I’d just say to make sure you really follow the directions with the creams and moisturizing as best you can.

    I’ve been on Lupron and an aromatase inhibitor for 6 months. It’s the pits! I’ve heard tamoxifen is more manageable in terms of side effects, so hopefully you’ll be just fine!

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  • lg10
    lg10 Member Posts: 71
    edited June 2018

    thank you so much! you really have made me feel a lot better. wishing you well on the meds. i hope it gets better and i will be thinking about you!

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  • Nickel103
    Nickel103 Member Posts: 42
    edited June 2018

    I’m glad! If you have any questions or run into any hiccups feel free to message me. Wishing you the best

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  • OCDAmy
    OCDAmy Member Posts: 873
    edited June 2018

    I had BMX with TEs then chemo and rads. My TE is almost up to my collar bone and the skin is super tight. I've decided to have DIEP. Have you considered that? It has much better results than implants on a radiated breast

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