Reconstruction after radiation - limited options?

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PurpleCat
PurpleCat Member Posts: 358
edited November 2018 in Breast Reconstruction

After last month's lumpectomy, I am planning on the radiation/tamoxifen route instead of mastectomy. However, in my initial visit with the radiologist, I learned that should this ever recur, I would need a mastectomy, and the radiation I expect to have later this month would then limit my options for reconstruction. I am of course hoping never to face that scenario, but am now wondering exactly what future options I would be ruling out if I went ahead with my radiation plan. Can anyone advise me on this?

Comments

  • Lula73
    Lula73 Member Posts: 1,824
    edited November 2018

    radiated skin does not like implants. And the skin may be so damaged from radiation that you may need to have the skin removed as well as the underlying breast tissue. Your recon option at that point would be natural tissue recon (DIEP, SGAP, SIEA, TDAP Flap). Actually long term, women have higher satisfaction rates with this type of recon anyway. I went with it right out of the gate to avoid radiation - my breasts look almost identical to the originals only perkier like they were before kids and the feel natural like the originals too.

  • dd1973
    dd1973 Member Posts: 13
    edited November 2018

    I'm in the middle of radiation right now. I plan on meeting with a plastic surgeon to discuss lipofilling, or fat transfer. From everything I've read, implants are not a good idea. While we probably shouldn't have implants, we are fortunate to keep our sensations b/c we didn't have a mastectomy.

  • mjb1018
    mjb1018 Member Posts: 170
    edited November 2018

    I've had implants for around 15 years and finished radiation in May after my lumpectomy in February...My treated side is now higher, tighter and smaller, not to mention the dent. :) I figured this would be a good time to put everything back where it belongs and bump up fullness and perkiness while I'm at it. While going into radiation, I knew it could cause issues, but she suggested with 100% certainty that capsular contracture will only continue to get worse. Had I not had radiation, my options for reconstruction would be much more open. If I choose do do nothing (because my breasts don't look too bad now), I may end up living with chronic pain. Thinking I could just swap out my implants and be happy isn't an option due to the radiated tissue. I thought that since I already had implants, I could just replace them. Nope. Her suggestion for me is a free flap reconstruction including implant (if still needed) and then match the non treated side. I learned that by doing a free flap recon, the healthy donor tissue can actually improve the health of the radiated tissue. I found that very encouraging. Anyway, I was searching around for a post like this, because I'd very much like to chat with someone who has had lumpectomy/radiation who has gone on to have flap reconstruction.

  • CaliKelly
    CaliKelly Member Posts: 474
    edited November 2018

    Hi, I'll tell you my experience. I had my radiation with a tissue expander in place, after all my rads, my skin recovered well ,so after expanding a couple of times, had exchange surgery for an implant. It was a fair match, in size and shape at first. Over the next year it started tightening up, and rose up a little higher, so then it wasn't a good match anymore. And it felt very firm. I decided to do what I should have done first, a lat flap recon. with implant I didn't have enough body fat for any other type of flap. It was successful and is a good match, feels more realistic.Pretty easy recovery. I am going to do a little revision to correct a little overlap on the side. Unfortunately I had a nipple reconstruction that died😕, so I'm having a tattoo done.

  • PurpleCat
    PurpleCat Member Posts: 358
    edited November 2018
  • macb04
    macb04 Member Posts: 1,433
    edited November 2018

    I sucessfully had a TE and Implant after Rads. I personally know lots of women who have done the same.

    Stop by the Prepectoral Implant Reconstruction thread and see what the other women are saying.

    ____________________________________________________________________________________________________

    Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES!

    Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

  • mjb1018
    mjb1018 Member Posts: 170
    edited November 2018

    Thank you so much for sharing your story CaliKelly! I appreciate it very much. I really was expecting to do an implant exchange, no big deal...I was a little devastated at first with her recommendation...I had brief moments of wanting a second opinion, but I trust this PS 1000%! I was ready to pay her out of pocket since she doesn't take insurance. She is that amazing. :) Your story lines up exactly to what she told me. She has seen breast cancer patients long term, and she said EVERY SINGLE time she has seen capsular contracture in women with implants who have had radiation. It's not really a question if IF, it's a question of when. Question...did you have anything done to your healthy breast, or just get the reconstruction to match? I'd like to get my left implant replaced, but understand that I might not be able to do it at the same time...May need to see what's possible for the let reconstructed side and let it settle out first...

  • mjb1018
    mjb1018 Member Posts: 170
    edited November 2018

    P.S. My trustworthy PS is actually referring me out to a clinic that specializes in microsurgery breast reconstruction. So, the good news is that it will be paid by insurance after all. :)

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