Reconstruction with a implant after radiation?

militarymom · New User Joined: 27 Feb 2005 Posts: 1

I had a lumpectomy 3 years ago on April 9th with Chemo and radiation following. Last year I had another biopsy in the same breast (it turned out to be a hematoma in the site of the tumor) which abcessed and took 8 months to heal. The Doctor says I can now have reconstruction done and have visited a couple of different plastic surgeons. The first one said he could take a flap from my back but could not use any implants because of the radiation that I had. This is what my medical oncologist had told me also. The second surgeon I visited said that he would also take a flap from my back but he would also use an implant. Now I am really confused. Which one is right?

sgishelly

I don't know that I will be much help...but I'm going through all the chemo and radiation now and my radiation onco told me that implants would not be a good option for me because of the radiation. Can't remember why....sorry!
_________________
Shelly
Dx Nov 1, 2004 at 40 y/o
Right MRM, Left Simple Mast. - 12/9/04
Stage 2A IDC -
Primary tumor 1cm
3+ / 14 nodes, ER/PR+, HER2-
34 rads - finished 5/25
chemo - AC and Taxol FINISHED 7/6/05
beginning reconstruction 2/06
brain mets 4/06 - now stage 4

Minnlady13

Can't help with your questions, but did want to say welcome to the board. I am sure someone will give you some feedback. Take care, Lauri
_________________
Diagnosed 4/11/1996
Lumpectomy, 6 mm tumor
Neg. nodes
ER/PR+
33 rads
Tamoxifen, 5 yrs.
NED

Blondie · New User Joined: 23 Feb 2005 Posts: 3 Location: New York

Hi Militarymom....the procedure you describe is called the lattissimus dorsi flap whereas muscle, skin and tissue are taken to create a new breast. An implant might have to be used in addtion if the remaining breast is larger. Below is a link thst you may find very informative as it may answer many of your questions Very Happy

http://www.cancerhelp.org.uk/help/default.asp?page=10563
_________________
-Eleanor-
I'm a 2x Survivor

marybeth · Posted: Mon Feb 28, 2005 8:12 pm Post subject: Implants/Radiation

Hi -- I am a very recently diagnosed BC patient and first time poster. I saw your question about implants and radiation. I too may need radiation following chemo (oncologist appt next week to review pathology report and determinefinal treatment plan). As I understand what I was told, implants MAY not be a reasonable alternative after radiation because the blood supply to the skin may be compromised from the radiation and in stretching the skin to fulfull a 'cup' size the skin may be too thin and split. I have been told by another Dr. that implants would not be out of the question if I opted for a small implant - A or B cup only and therefore a minimum amount of stretching. Don't know if this reasoning is accurate for your situation, but hope the information helps! MB
_________________
Dx 12/28/04 at age 51
DCIS and ductal carcinoma invasive
6mm tumor
lumpectomy 1/5/05 unsuccessful margins
left mastectomy 1/14/05
1 +/5 lymph nodes
Chemo started 3/15 AC, then Taxol
Herceptin 6 rounds/stopped b/c of low EF
Armimidex
right prophylactic mastectomy 2/17/06
Implants 1/07, final w/tatto 9/07

RachelEsther

I had tissue expanders put in at the same time as my mastectomy. I had chemo and radiation (28 sessions). About 12 weeks after radiation, I had a silicone implant put in.

I talked to my PS about this, because there were a number of posts on the Komen board where women with radiation in the future were told that they could not have tissue expanders/implants.

My doc told me the following: He will only do tissue expander reconstruction BEFORE radiation. That is, the expander goes in before the radiation, and it is fully expanded (all the fills) before radiation. He overfills it, so that it will have plenty of room for afterwards. He will not do the implant surgery until at least 12 weeks after radiation is complete.

Radiation does toughen the muscles so that it is a bit less flexible than if you did not have radiation. That means it does not stretch well. But any stretch put into it before radiation is there to stay. He says he gets really great results doing it this way. He will NOT, however, do any tissue expander/implant reconstruction that starts on an irradiated breast. You have the get the muscle stretched BEFORE the radiation. He says he does not get good results putting the expander in AFTER radiation (ie, reconstruction starting after radiation), and he will not do that surgery.

I have been very lucky I think. My skin is virtually unharmed by the radiation, and the muscles did extremely well, and are not too badly thickened or rigid. Both the PS and my radiation oncologist say that my skin and muscle after radiation is just about the best they have seen. Genetics, apparently, although I did moisturize like crazy.

After my implant surgery, it took a good 2-3 months for the swelling to go down - a combination of having 10 nodes removed, and the irradiated tissue retards the outflow of the swelling. I am now 3+ months out, and the implant breast is looking better bit by bit, projecting more and losing the pancake look, but I have to massage it every day to guard against encapsulation, and to force the implant down so it'll project and have a bit of droop. I thought I would be able to have the nipple put on and the other breast lifted for symmetry at 4 months, but at this point I think that that is optimistice. However, it looks pretty darn good even now when I am naked, and in a bra, it's fabulous (I need a bra to give some symmetry).

I have to tell you that I have healed incredibly well and quickly. I have had no complications at all from my surgery.

I think that the problems you indicated, the skin splitting, and blood supply problems, would arise if you had the implant put in AFTER radiation, when the skin and muscles are less flexible. I think that this is why your surgeon said that he could put in a small implant with the lat flap after radiation, because it would not need all that much stretch. And if he is going to use the lats, they have been unaffected by the radiation, so it makes sense that he could put in an implant - although if that is true, I don't understand why it has to be small - maybe there is some tissue that was irradiated that stays and that's the limitation. Oh, that is confusing, I'd ask for more info.

I also believe that my doc said that he would not do any flap reconstruction at any time, before or after radiation, for women having radiation, because the results were not good. I would check that out.
_________________
Rachel
Age 50 at diagnosis, Stage IIIA
IDC grade 1, DCIS grade 2
LB Mastectomy, Expander Recon 3/3/2004
Dose Dense Chemo completed 07/01/04
Radiation completed 09/02/04
Silicone Implant 11/22/04, removed 7/05 due to infection (dental cleaning), replaced 12/05. Reduction RB for symmetry 04/06
Tamoxifen 10/04-10/06, Arimidex 10/06 on

hhmv73a · Experienced user Joined: 16 Jan 2005 Posts: 95

Dear Militarymom,

It is true that radiation will delay healing after a surgery, but I am not sure whether an implant can be used or not. I think you need opinion from plastic surgeons.
Sorry I cannot offer much help here.

Good Luck,

Dr. Jay Lu

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