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implants when you have to have radiation

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I had a mastectomy one month ago with expander placed at time of surgery. I have not needed to take any pain meds post surgery- I have a pretty high tolerance to pain- but the expander is terribly uncomfortable and aesthetically doesn't look anything like a breast, very tight and constricting under my armpit—I think maybe the expander is stitched in there. After a month I am getting somewhat used to it and getting range of motion of arm back. I know the flap surgery is recommended if you have radiation but I really don't want to have another major surgery and so I was planning on getting implants. Unfortunately I also have to have radiation and have learned that the two do not go together well. The thought of having to wait after radiation and having the expander in for eight months seems unbearable. A couple of weeks ago my plastic surgeon recommended replacing the expander with the silicone implant prior to radiation instead of after. He consulted with my radiologist and breast surgeon and they said it was okay to do it in that order, even though it is not usually done that way. But the oncologist said don't do that— you will wind up with capsular contraction and it will be awful. The Plastic Surgeon says the risk of that happening is the same whether you do it before or after the radiation and the benefit is that he doesn't have to cut into radiated skin to put in the implant—the risk of infection when cutting into radiated skin is high. But the more I find out, the more I feel that the implant is too risky, but all the other options- flap surgery or going flat-seem equally horrible. Has anyone had the implant put in before radiation and what was the result? I am feeling so overwhelmed by all of this, and it is especially hard when you are getting different messaging from your doctors. I am scheduled to have the implants put in next week and I am panicking!

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  • triscuit
    triscuit Member Posts: 34
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    Hi @annrita. I don't have experience with radiation so I can't answer your question, but I wanted to just stop in and say I'm sorry you are going through this. I'm almost 6 weeks out from mastectomy and expander placement myself and I sympathize with you on the discomfort with expanders. I think some do stitch them down and others don't. Have you had fills done? For me I think that has actually helped with the discomfort, but I don't have that same feeling that they are under my armpit.

    Hopefully others will come along who have relevant experience and advice about implants and radiation. Can you get a second opinion from another plastic surgeon? It's hard to sort through conflicting advice.

    One other thought - have you checked out the threads TE Trouble or TEs: a Beginners Primer? Neither have been active for a while (though I posted yesterday to the second one to see if it might create some more activity. But if you are interested in reading through those a bit I'm sure there are women who had radiation that talk about their experiences.

    Best of luck to you and hang in there.

  • wondering44
    wondering44 Member Posts: 261
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    Hi there,

    I had implants placed before my cancer diagnosis. The plan was to leave in the implants and do fat grafting after I completed treatments. My PS said I had to wait about six months after radiation to do the fat grafting. He explained he didn't want to do anything to the radiated breast due to the high-risk from the tissue damage from radiation. I ended up with capsular contracture a couple of months after radiation. I covered up my boobs with bigger shirts due to the look. I wasn't at all happy with the look. Fast forward a bit…I ended up a year later doing a BMX and the existing implants were removed and TEs were placed. The TEs were uncomfortable to say the least. I couldn't imagine keeping those things in for eights months. I had them in for three months and it wasn't a walk in the park. I was advised against doing the TEs & implants after the radiation due to the risk of infection and tissue damage surgery may cause. I was told by my oncology breast surgeon if I didn't heal up that I'd have to go back and remove the rest of the skin from the skin-sparing mastectomy. I wanted the implants and understood the risks. I ended up healing well from the surgeries. My cancer breast actually healed up easier than my non-cancer breast. I had the implants placed a few months ago and could not be more pleased with the results.

    So, you can do one and no issues or you can do one and be the person who has issues. Unfortunately, you simply won't know until you choose one and move forward with it. We are all different and one person may breeze through it and another may not. I figured I could always go back and have the flap surgery if the TEs/implants surgeries weren't successful. That was just my choice. Others may have different insight and experiences to share with you.

    Honestly, the choice is 100% yours to make. The doctors are there to guide you in your decision-making based on their medical knowledge. However, your body is the one that ultimately decides how well you will do with the surgery you choose.

    I wish you speedy recoveries on your upcoming surgeries.