Topic: Lift/Reduction to radiated breast?

Jennifer,

Thanks so much for responding.  My PS plans to proceed with a modified lift/reduction to minimize the amount of tissue cut.  He plans on a very short transverse incision rather than cutting along the entire mammary fold.  I am not too worried about more scars as I already have some good ones and I suspect the new ones will be less conspicuous. 

After you have already had lumpectomies with radiation you are now proceeding with bilateral mastectomies?  Please let me know what your PS says about reconstructing with the DIEP procedure.  You are taking on a lot more surgery. 

I didn't know that radiation therapy forever changes the tissue radiated and that when it heals it is full of scar tissue.  My PS said that when he cuts the radiated tissue the blood vessels don't close up to stop the bleeding normally.  He said they stay in the open position because the walls are stiff with scar tissue.   Healing apparently takes about twice as long as there are also fewer blood vessels. 

This is my very untechnical understanding.  If anyone knows better, please add your thoughts.  I wish I had known when I made the lumpectomy decision that any future surgery was iffy. 

"Surgery of the irradiated breast includes all of the pitfalls of any breast procedure, including scarring, nipple malposition, contracture, infection, postoperative pain, and the additional hazards related to unpredictable healing in radiated tissue." Reconstruction of the Radiated Breast" Feb 2009 http://www.plasticsurgerypractice.com/issues/articles/2009-02_03.asp

Betsy

On May 14th I had bilateral reduction and lift.  The right side had lumpectomy and radiation.  The recovery has been a bit more challenging than I had expected.  I am worrying a lot about the healing process.  The PS has reassured me that I will be happy with the final outcome...he says it takes up to six months for the swelling to subside.  I am glad to say that I have sensation already in both nipples. 

I hope others will post here because I have had a hard time find other women who have chosen this option.... 

Hi Betsy - the tumor was actually 1.2 but the format of the the board does not allow for that.  It was staged at II by the pathologist....and when I asked the onc about the staging he said they staged it at II because of the aggressiveness of the Triple Negative.

You are right - I  waited 18 months to let all the tissue settle down... the "good"  breast seems to be healing fine but the radiated  breast is having problems - as the PS had anticipated.  The spot at the "T"  where the three incisions come together is open.  I just keep putting neosporin and a dressing on it.  I am supposed to return to work on the 8th.....Keep me up to date with your process...feel free to email me at hhamlett@gmail.com if you want...or we can talk on the phone if that will be a help...

best,

H

I had a lumpectomy with radiation 24 years ago.  A year ago I had a MX and immediate reconstruction using the Lat Dorsi Flap procedure and Tissue expander placement.  I had no problems with healing and so far no problems with Capsular Contracture which is more common in a radiated breast........

These threads always come along at just the right time!  I had a lumpectomy last May and finished radiation in November.  I am having a lift and reduction this Friday (June 5).  My PS is actually a breast cancer survivor herself, so I'm pretty comfortable that she understands the issues with a radiated breast.  I definitely have scar tissue since radiation but my skin held up beautifully.  I don't have any discoloration or any other obvious problems so I am hoping and praying for good results.  I'm very interested to hear about other's experiences.

I am glad I logged on this evening.  I have been thinking about a lift and reduction but decided that I should wait a while longer.  My last STANDARD chemo was May 08 but my trial chemo was Nov 08.  So it hasn't been that long ago.  My husband thinks I am fine but I really want more symmetry.  I am like most in that I still wear my same bra.  The difference is when I have something that lies across the bust that I can see the difference.  Also, I notice it in a bathing suit.  Please keep the posts going for those that have appts.  I plan on doing it in the not so distance future.

I am so grateful to have found this discussion! I am a 7 year breast cancer survivor who wants to have a breast lift and reduction. My breasts are different sizes and I had radiation -- no chemo. The first PS I met said there was no way I could have surgery because of the radiated skin (located underneath my left breast). Given it's been 7 years and my skin is "okay," what opinions or knowledge is out there about taking this on. My skin is slightly discolored and is tender  feeling occassionally. The location of the radiated skin is right where the PS would operate so I may need another option. Can the PS reconstruct using another procedure than the "T" approach? I'm okay with scars -- just want to look better in my clothes and be the same size.

Wow, this topic has hit a nerve.  Welcome all.  I thought I was the only one struggling with the viability of surgery to a radiated breast.

Tamara,  Probably your doctors will point you to a reduction on the unaffected side, as that is a more reliable outcome.   I agree with Holly that seeing a PS now doesn't advance your objective.  You wouldn't want to postpone chemo to have plastic surgery now. 

Tracy,   I hope today went well for you.  Please give us all the details.  Did your surgeon modify her usual technique to maximize healing?  Did she use a drain?  Did you spend the night in the hospital?

Linda,  When did you have your MX and reconstruction?  Was it just recently?

Jennifer,  You are so right; each of us needs to sort out what is best for us.  The information and experience of others helps so much, but in the end we find our own path.  I really appreciate knowing that if I need a MX in the future that the immediate DIEP is an option.

Carolyn,  I'm in Bangor!  My husband thinks I'm fine also, but I don't.  I consulted with two PS and choose the one you have extensive experience with lift/reduction to a radiated breast.  The other was very confident, but had only done it a couple times and was planning a standard procedure, outpatient, probably no drain, and f/u in 10 days.  The experienced PS plans a modified procedure, overnight in the hospital, definitely drains, and will see me the next day. 

Vickie,  Look for a PS experienced with surgery to the radiated breast and who has lots of past success.  I found one and I'm sure you can as well. 

Sirsmom,  Best wishes on your surgery.  When is it planned?

Holly,  Good luck on Monday when you go back to work.  Have a restful weekend.

Betsy

DX 3-18-08: Bilateral BC - IDC, 1.8 cm, Stage 1, Grade 3, 0/1 nodes, ER-/PR-, HER2+

                                             DCIS, high nuclear grade, ER+/PR-

Hello Sirsmom, Tamara, Betsy, Vicki, Jennifer, Linda and Carolyn...did I miss anyone(?)...hope not...

I agree that each of us needs to find her own path and follow it with confidence.  My decision was based  on wanting to 'reclaim' by body back from cancer.  Also - mid-way during my treatment my partner of 13 years left me for a younger and as he said (non-scarred) woman.  I have more scars now but they are ones that I chose - they didn't get chosen for me.  So for me - thsi has been the right decision.

I still have a long ways to go in terms of healing.  The incision is open and continues to ooze.  I feel pretty fragile and very, very aware of every movement.  My breasts feel uncomfortable and super senstive and that is getting 'old' very quickly.

Sirsmom - I wish you well on July 7th...keep us posted and  Tracy - I hope is went well...please let us know how you are doing....

Best to all....gentle hugs from Holly

Hi Boo -- thanks for your posting and advise to find someone experienced with radiated skin. Can you tell me how long you waited after the radiation to have cosmetic surgery? It's been 7 years for me and I am hoping that plays in my favor.

I will take your advice and try to find a PC who has experience. The first PC didn't suggest that as a solution and I was so shocked when she said I couldn't have surgery, that I didn't know what to say. Now, I'm researching so have more questions during a future consultation.

Vicky,

I plan on having the surgery December 2009.  My surgeon said it best to wait one year after radiation, October 2009 for me.  She said there is no advantage to waiting longer.  I would think your seven year interval is all to your benefit. 

I was also shocked when I learned that radiation severely complicated any future surgery.  Not one person mentioned that as a guaranteed side effect of radiation; not my surgeon or radiation oncologist.  I specifically asked about future reconstruction for symmetry and neither made even a reference.  I found out myself online on this website under "Ask the Expert" regarding reconstructive surgery. 

I might add there was no reference to it either on the BC.org website under "Mastectomy vs. Lumpectomy" or under radiation therapy.  I have complained and they added a passing reference under "M vs. L".  It would be best to have a full discussion under radiation as well.  

Tracy,

I'm glad to hear that so far you are doing well.  For the swelling you might try a trick I learned.  Prior to surgery, I had bought a large bra at Wal-Mart that closed in the front.  In the first days after my surgery and then re-excision I would wear the large bra over the surgical bra and pack a bag of crushed ice in each side!!  It was a very voluptuous look from the right angle!  The fabric kept the ice off my skin and it gave much needed comfort. 

Betsy

I have to admit that all this discussion of drains has gotten me scared. I keep telling myself it can't be that bad. Because my tumor was in such a strange place(breast fold chest side, into my chest wall) I had a significant amount of my affected breast removed. My scar runs down my chest across the entire bottom of my breast. Yet, within a week of surgery I had resumed almost all normal activity. How bad could a siimple lift, reduction be? Of course, i didn't have a drain last time.

Hello friends...yes - I am almost one month out from the bilateral reduction and lift (post rads to the right breast).  I have been very worried about the incision under the right breast which is opening and oozing.  I went back to work yesterday.  I had a plastic surgeon at the hospital where I work take a look cause I was so worried and had to wait till Friday to see my PS - she (my plastic surgeon colleague) took a close look and said everything is healing just fine. It is expected that radiated tissue will take a lot longer to heal. She said - up to 6 months....

It's not that I don't trust my PS - cause I do, but my colleague has no vested interest in giving me 'the party line' about how everything is going to be fine....she honestly thought it all looked good and she would tell me honestly if I were in trouble....

I have survived two days at work ( 3 weeks post op) and am doing okay - very tired and sore at the end of the day...but nothing that  a nice glass of wine when I get home does't cure...

RE: drains - there are no two ways about this - they are GROSS....I had two and I hated them every moment...but they were only in for 5 days and then got ripped (and I mean ripped) out...thank god....so now they seem a distant memory...isn't it amazing a;ll the stuff we deal with and then move on...

Seems I may be a bit ahead of the curve in this group so please ask any and all questions and I will help as best I can...

Actually, I think the 6 months figure is pretty good.  After I had to have abscesses cut open and drained in my irradiated breast the wound specialist told me it would be a year to heal the incisions, and that was with me going into a hyperbaric chamber for 2 hours every weekday for all that time.  After losing an entire summer to daily treatments and excruciating pain I had the breast taken off.  I had the drain in for 3 weeks, and it took 6 weeks for the incision to heal and for me to be cleared to get fitted for a prosthesis.  I would have been very upset to have to walk around for 6 weeks with no bra and no left breast (I am large breasted) but not being in constant pain anymore made the embarassment MUCH more bearable.  Of course, I got the abscesses because I got too much radiation, so women who get the proper amount of radiation probably do quite well with healing up after surgery later on.