Implant reconstruction after radiation
I have a recurrence of DCIS in my right breast. In 2017 I had a lumpectomy and radiation. I now need to have a mastectomy and I’m hoping to have an implant reconstruction, rather than the DIEP flap. Most of the conversations I’ve found on the success of an implant reconstruction years after having radiation are pretty old. Can anyone tell me about their more recent experiences?
Thank you in advance for sharing! This is such a difficult decision.
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My timeline isn't quite aligned with yours, but I had implants and radiation. I was diagnosed in August 2021, and in October 2021 I had a skin-sparing BMX with direct to implant construction. However, then they found a mass in a node, so I did chemo, then radiation. At the time, I don't think radiation really affected my implant - I had issues with them, but the issues were on both sides, not only my radiated side. Eventually I decided to go DIEP, and even though it's been a couple years since I finished rads, the radiated side has been really tough to heal (think skin grafts and dead tissue). It's my understanding that the radiated skin just doesn't stretch/adjust. You might ask your surgeon what they recommend - maybe going with a little smaller implant to ensure the skin isn't stretched too far, or starting with an expander which can be filled as tolerated. Everyone's a little different. Good luck!
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By the bay I had lumpectomy and radiation in 2015. Just found out brca2 positive so I had a preventative masectomy on Feb 27th. So far my radiated side is not filling below the scar line. Other breast is filling up fine. I have 400cc in now. It does not look like I'm having a failure. Dr said she will repair in exchange surgery but said that side will always ride high
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@herb thank you for replying. I'm new to all of the terminology and not sure how the process works. What does it mean "not filling below the scar line" and "filling up" is that the tissue expanders? I'm assuming "exchange surgery" is putting implant in? So the radiated skin is not cooperating but not a failure? Did they need to add more skin? I'm sorry, I'm just learning how this all works and appreciate your helping. I sure hope it all turns out the best for you.
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So my expanders have a port that is used to expand the muscles to at later date place the implants. The surgery to remove expanders and insert implants is called exchange. My issue is that I had radiation 8 years ago for breast cancer and my radiation breast is not expanding on the bottom. I have been expanded 4 times and have 400cc. Next week will be at 500cc. The bottom of that breast is flat below the incision line forcing the implant high in my chest up into my underarm. Looking to see if anyone else with prior radiation treatment had a later masectomy reconstruction with expanders and what thier result was.
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@herb thank you so much for explaining. I hope that others with prior radiation experience can offer some info. My experience was radiation 26 years ago but I am contemplating not using an expander but staying the same size and hoping my skin handles it. Thanks again.
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@BYTHEBAY My PS said they can't put implants in directly on a radiated breast. This is why I have expanders and I did ask about direct implants. I am going for a B cup. I will be interested in seeing what they tell you.
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@herb Thanks for telling me that, I may have misunderstood but I thought if I stayed the same size as my smaller breast is, he could go direct with implant, no expander. I have so many more questions for my next visit with him. Thank you and I will let you know, wouldn't be surprised if I misunderstood with so much new info coming at me.
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I just reached the end of my expansion. My radiated breast was giving dr resistant pressue during the fill so she stopped adding. That side is at 550cc the non cancer side is filled to 600cc. We are going to wait a week and a half so she can add the 50 cc to the radiated breast. I am at a b cup. In my research I found that there are high fail rates on a previously radiated breast and reconstruction. My PS keeps saying 40% fail rate. Right now no sign of necrosis, infection, failure to expand or other issues that would cause an abandonment of expanders. Now we wait the 3 months or longer exchange surgery. The Ps said maybe September exchange date.
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@herb very happy for you that there aren't any issues right now. I'm sure you are anxious to get to exchange and recovery. I wonder if it all depends on your skin, how much time since radiation, probably a combination of it all. May I ask if you did nipple sparing?
I just got results from Genetic testing and it was all clear. I tested negative for BRCA back in 2009 but with so many new mutations found I decided to test again. I am impatiently waiting for a surgery date, I am so anxious I just want this done.
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@bythebay I was a dd and because of radiation they can't go large expansion. So I did not do nipples, plus if you look up nipple reconstruction on YouTube you will see the end result looks better. They can make perfect nipples with a simple skin surgery and tattoos. Even just tattoos look so real. As for the issues with a 40% failure rate of reconstruction after radiation treatment, I feel that some of this is due to chemo. Most of the past lumpectomy radiation to masectomy with implants will be due to a new local breast cancer. I am a weirdo because I had my brca test 8 years after my original cancer, so no chemo to impair my healing process. The only issue is the skin is not elastic and does not want to give like the other side.
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@bythebay I do hope you can do nipple sparing mastectomy with direct implants. Had this been an option I would do it. My issue was one breast was dd other breast c cup due to radiation. And no way to get any symmetrical outcome due to the amount if skin they need to remove. In fact I still need more skin removed on the dd side. I am more concerned with symmetry than large breast at 64 years old. I just want to have a bust line and not be flat or concave. So b cup is fine.
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@herb Thanks, I hope so too. My rt breast had lumpectomy and radiation 26 years ago so it was smaller than the left and as I aged, the difference in size became more pronounced. I am having the rt breast mastectomy and the left breast is getting a reduction so I can have symmetry as well. I will be 70 this year but I live by the water and spend time kayaking and wearing bathing suits. Like you, I'm fine with staying the size that the smaller one is now which is like a B. I'm praying that with my breast staying the same size and not expanding, the skin will be okay. Still not on the surgery schedule. Thanks @herb
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@bythebay why not just do a double and get it over. The pain of the reduction oneside and mastectomy other is not going to be much different to the total masectomy. I would get it done and not deal with this breast cancer issue again. If your able to get direct implant you will be fine in 4 weeks. If I did not have expanders I would be totally functional by now. I am 6 weeks out. Also they can get better symmetry if they do both
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@herb I had been going over it in my head whether doing one or both and have decided to do both. With all things considered it really does make more sense. When I was 43 and diagnosed it all happened so fast, it was found and the following week it was out by lumpectomy and I had radiation. This time there is so much more to consider. My first visit with the breast cancer surgeon she asked what I wanted and I didn't realize how unprepared I was because I had no clue. I really appreciate your input and hope you are doing well.
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@zengirl I hope some of our conversation has been helpful to you. Have you found out more about your options? My radiation was 26 years ago and I have decided to do mastectomy with direct to implant reconstruction. I don't want to do expanders because I am okay with being the same size as my smaller breast and I am hoping for one surgery. I hope you are getting all the info you need for your options.
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@bythebay the radiation side is the only side that hurts when i get expanded. The tissue is so rigid and not elastic. I have 1 more fill. I can tell you smaller amounts of cc do not make any difference on pain. I thought if we do 50cc instead of 100cc it would be les painful. I take a muscle relaxer day of fill and for 2 days after. Good thing is I did my fils in 7 weeks total. Your radiation side will limit the size of last fill. When my dr said she got back flush in the needle, I knew I was done expanding. I also figure if they are going to take part of the breadt tissue on the non cancer side for a lift, the pain will be no different. The masectomy was not bad after the drains came out. I was good at 2 weeks from the surgery. The expanding hurt more than the masectomy by that point. Also make sure you put everything you need down at arms reach. There will be no over the head for fie about 4 to 6 weeks. I am 8 weeks out and did a chair yoga class today. Only thing I could not do was get my arms over head. Good luck. I think your make a good choice
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@herb I had quite a few days of decision making and above I told you I had decided on bilateral mastectomy. I have gone back to my original plan which was mastectomy on the cancer breast with reduction and reconstruction with my own tissue on left breast. I got kind of taken up with questioning about why I wasn't doing both….and I went off my plan. After further time and discussions with both of my surgeons, I have decided to stick with my original plan. Its such a personal decision for everyone and I needed to remember that. For me I feel so blessed to have had the lumpectomy and radiation at 43 and not a mastectomy because I had my own breasts through my 40's, 50's and 60's cancer free. Thats a long time and I feel good about my plan and isn't that what its all about for all of us. All of my genetic testing was clear.
Sounds great that you are doing so well and did a chair yoga class, thats awesome. Thank you for the tips. It must be hard not being able to lift your arms up. Are you doing any medication?
I will definitely be going straight to implant on the mastectomy side. They will determine which implant size will work with my skin, starting with 500cc. They cannot use fat grafting immediately but if after I heal I am not satisfied, it can be done then. The left breast will be reduced to match the right, with a lift using my own tissue at the same time. My breast cancer surgeon and my plastic surgeon will work together. I am now just waiting for the date, hopefully soon.
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@zengirl, I might be too late with this information on your question but maybe it can be of help to someone. I had DCIS 5 years ago and had a double mastectomy straight to implants. A year later I had a DCIS recurrence so had that lump removed and had 25 sessions of radiation. The implant coped fine but that side has been more tight than the other ever since. Last year (so 3 years on from the last surgery), my other side's implant ruptured so I needed to have it replaced. The plastic surgeon replaced both sides. The radiated side definitely did not heal as quickly and it was red for a while, which really concerned the surgeon. I was on two sets of antibiotics and some further meds to resolve. She also had that arm in a sling to avoid me from moving too much. It eventually resolved but unfortunately in exactly the place where the redness was (above the implant, higher up) I found a lump (4 months post surgery) which was biopsied and found to be invasive Her2+. Started chemo and herceptin. So if you do get implants after radiation, I would advise that on the radiated side you have to be very careful with movement etc. No way to really know but I did wonder if the redness and issues did not lead to the development of the new invasive issue. My breast surgeon feels that the cancer cells might have already been present at the time of the operation last year. Will never really know.
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Thank you so much for sharing your experience, @tessie007, and welcome to our community! If you need anything, please don't hesitate to get in touch. We're here for you!
The Mods
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Hello @tessie007. Thank you for sharing this. You’ve really been through it … but you sound so positive!
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Hello @tessie007. Thank you for sharing this. You’ve really been through it … but you sound so positive!
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Sounds like you have a plan. Please let us know how the direct implant works on the radiation breast. My PS would not even try it. Your lucky. Hopefully our post will help others who have to decide what to do years after a lumpectomy and radiation.
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