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Topic: Skin-sparing mastectomy with implants after radiation

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

Posted on: May 29, 2017 10:40AM

Goldfish wrote:

I had stage 3 breast cancer in my left axilla ten years ago. I had 6 rounds of chemo (FEC), lymph node dissection, and 25 rounds of radiation. I now want to have a double mastectomy with skin and nipple sparing with implants. Has anyone ever had this surgery after radiation? My plastic surgery is happy with the condition of my radiated skin on my left breast.

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May 30, 2017 06:45PM Alli wrote:

Many folks have had good outcomes with implant recon after rads though many PS don't prefer doing this and a lot of time will recommend a flap recon instead.

But it is possible. Just know that there are higher risks of complications and choosing the right PS is very important.

I sent you a pm as well

Good luck

Alli

Dx 11/2/2006, IDC, Left, <1cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2- Surgery 11/30/2006 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/1/2007 Whole-breast: Breast Dx 11/8/2016, DCIS, Left, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 1/5/2017 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 1, 2017 11:06AM Sunrisefish wrote:

Hi Goldfish, yes, I have had this done. My original diagnosis was in 2014. Stage 2, right side. I had lumpectomy and 15 rounds of double dose radiation. I did not have chemo as oncotyoe scored a 3. I felt a lump again on the right side in May 2016. Had a mammogram and ultrasound, both said the new lump was not cancer. Had an MRI in Dec 2016, which also said the new lump was benign. I finally insisted they take it out in March, which they did.. and it was the original cancer back. I just had a skin, nipple sparing BMX on May 17th with direct gummy implants at time of mastectomy. My skin also looked good. I am just over two weeks out and both breasts look great. I have feeling in both, pain is minimal. My breasts are lumpy and hard, but healing and getting better every day. It is crucial that your surgeon and plastic surgeon are top notch. I am not out of the woods yet, but everything looks great so far. There are others on the site who have had this done successfully as well.

Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 1, 2017 05:14PM - edited Jun 1, 2017 05:49PM by Goldfish

Thank you so much for sharing your story. Are your implants prepectoral or subpectoral?

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Jun 1, 2017 06:41PM Sunrisefish wrote:

My implants are sitting on top of the muscle. Surgery had been relatively pain free because of this. I have full movement in both arms, even though I sm not supposed to move them that much yet.

Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 1, 2017 06:52PM Sunrisefish wrote:

I was warned that complications could be higher. My plastic surgeon estimated my success rate at 80%. The only alternatives are much more invasive surgeries or going flat.. Worst case scenario, it won't work and you start over with one if the flap surgeries. To me, the least invasive surgery is completely worth a try. Many others have had it done succesdfully, and pladtic surgeons are doing it more often. The new implants are supposed to be better as well for radiated tissue. You can always have a flap surgery if it doesn't work. For me, so far so good , I have no hint of anything going wrong 15 days post op.

Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 1, 2017 07:00PM stephincanada wrote:

Hi sunrisefish,

What type and shape implants did you choose? I had the same thought re: trying the least invasive surgery first. Will you continue toget screening MRIs or mammograms because the implant is on top of the muscle?

Good for you for following your instinct and insisting that the lump be removed!

Dx 5/26/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 6/7/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/7/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 9/6/2016 Herceptin (trastuzumab) Targeted Therapy 9/7/2016 Perjeta (pertuzumab) Radiation Therapy 11/29/2016 Whole-breast: Breast, Lymph nodes
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Jun 1, 2017 09:07PM Sunrisefish wrote:

The implants are natural gummy implants 450cc. They are the new ones that are shaped like the natural breast, sloped and larger at the bottom. I believe the gummies are less likely to have capsules contraction, and are more recommended for radiated tissue. It's too early for me to love them, as they are still hard and lumpy 2 weeks out from surgery, but I know they take at least 6 werks to settle, and most women are happy with the final shape. My plastic surgeon may do a little fat grafting down the road to perfect them and strengthen the tissue. I was a small C cup before, and am probably a big B now, not really a big difference, and I can wear all my old bras which I love. All in all, having this surgery in front of me was MUCH harder than having it behind me.

I have been told I will not need screening, besides physical exams of the skin. I know there is some controversy on this. My oncologist says if anything starts to grow under the implant I would feel it.

Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 2, 2017 05:04AM stephincanada wrote:

Thanks for the info. Very helpful.

Dx 5/26/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 6/7/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/7/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 9/6/2016 Herceptin (trastuzumab) Targeted Therapy 9/7/2016 Perjeta (pertuzumab) Radiation Therapy 11/29/2016 Whole-breast: Breast, Lymph nodes
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Jun 2, 2017 06:20AM Goldfish wrote:

Sunrisefish, you have been very helpful, thank you. Speedy recovery.


shephincanada, I'm also in Canada, where are you? Have you been able to find a surgeon who does prepectoral implants?

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Jun 2, 2017 08:45AM stephincanada wrote:

Goldfish, I will PM you.

Dx 5/26/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2+ (IHC) Surgery 6/7/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 7/7/2016 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 9/6/2016 Herceptin (trastuzumab) Targeted Therapy 9/7/2016 Perjeta (pertuzumab) Radiation Therapy 11/29/2016 Whole-breast: Breast, Lymph nodes
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Jun 2, 2017 08:52AM Sunrisefish wrote:

I will keep the thread updated with my progress, since I am not out of the danger of complications yet. I know many of us are in the same situation and interested in the success of implants after radiation. Will keep you all posted! Good luck ladies! Keep us informed of your decisions. You all have friends, love and a world of support here.

Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 5, 2017 06:25AM rdsm wrote:

I had BC in 1999. Lumpectomy, chemo and radiation. Fast forward to 2017.............Just had a skin sparing, nipple sparing bilateral mastectomy in April. I have expanders now and am going for my 3rd fill today. I am also going thru chemo again now. Will have surgery in Sept to swap out expanders for implants. So far, I'm really pleased with my results!!

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Jun 7, 2017 05:57PM Goldfish wrote:

rdsm- that isgreat to hear. My radiated side is causing me a lot of stress. I'm so happy you're having good results. Will you be placing your implants under or above the muscle?

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Jun 8, 2017 04:51AM rdsm wrote:

Goldfish: Under the musle

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Jun 19, 2017 11:45AM Goldfish wrote:

sunrisefish, how are you doing?

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Jun 19, 2017 01:03PM rdsm wrote:

goldfish: under the muscle

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Jun 20, 2017 10:49AM Sunrisefish wrote:

Hi ladies, I will be 5 weeks out from surgery tomorrow. Had skin and nipple sparing BMX with direct gummy implants on May 17. Initial diagnosis in 2014 with lumpectomy and radiation in 2015. I am still doing great. Very little pain. Both breasts look fine. No sign of infection. My scars are healing nicely. I have full feeling on the skin of both breasts. The nipples are both numb. The non radiated nipple has full erectile function, the radiated side has less, but she's hanging in there. The implants are naturelle 410s. They feel wide and flat on top, since they are sloped. I know the shape will continue to change for awhile. They started out feeling very hard, but are getting softer all the time. My PS may do fat grafting down the road to even out the flat parts in the upper pole. All in all, still doing well!





Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 20, 2017 10:52AM Sunrisefish wrote:

oh forgot to mention, my implants are above the muscle... which I am sure is the reason I have full movement in both arms and very little pain.




Dx 10/2014, IDC, Right, 2cm, Stage IIB, Grade 2, 0/4 nodes, ER+, HER2- Dx 3/2017, IDC, Right, <1cm, Stage IA, Grade 2, ER+, HER2- Surgery 5/16/2017 Mastectomy: Left; Reconstruction (left): Silicone implant Surgery 5/16/2017 Mastectomy: Right; Reconstruction (right): Silicone implant Radiation Therapy Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Right; Lymph node removal: Sentinel
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Jun 21, 2017 09:09AM Goldfish wrote:

Sunrisefish- I'm so happy to hear how well you're doing. It gives us radiated gals a lot of hope. Continued healing and keep us posted.

rdsm- were your expanders placed above or below the muscle? How did you find the recovery after they were placed?

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Jun 22, 2017 06:42AM rdsm wrote:

Goldfish: my expanders are in below the muscle. I have had no problems with them at all. I have full range of motion and I like how they look. I am scheduled for a Sept surgery for the swap out. Haven't yet discussed what implants I will be using with my PS yet.

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Jun 29, 2017 09:31AM FLBuckeye93 wrote:

The surgeons at The Center for Restorative Breast Surgery are wonderful. I had radiation prior to my BMX and SGAP surgery. I met with three plastic surgeons before consulting the Center. It is worth it to at least contact them for a free consultation. You do not have to travel there to consult.

Dx 10/2015, DCIS/IDC, Left, 3cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Hormonal Therapy 6/21/2016 Aromasin (exemestane) Dx 10/2016, LCIS, Right, 0/1 nodes Surgery 6/20/2017 Mastectomy: Left, Right; Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Radiation Therapy Whole-breast: Breast, Lymph nodes Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery Lumpectomy: Left

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