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Topic: Breast reconstruction complication (radiated breast)

Forum: Breast Reconstruction —

Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Jun 18, 2019 08:09PM - edited Jun 19, 2019 09:39PM by plite

plite wrote:

Hi - I'd love to learn from anyone's experience with an LD flap or without a flap on skin that was previously radiated.

My situation: stage 1 cancer with lumpectomy and radiation. Diagnosis 3 years later of stage 0 with mastectomy as treatment. I have an excellent plastic surgeon who thought I could proceed without the flap (my skin looked great). However, my skin didn't deal well through the expander and implant process (looked like capsular contracture to me and felt tight). Along the way I developed redness, inflammation and a tiny hole along the incision line. Blood cultures were done after the implant removed and no infection. So, now I'm waiting to try again and I was under the initial impression that an LD flap was definitely needed this time around, however, after seeing how I'm healing now (skin looks great again), my surgeon is thinking that I may not need a flap or I may need a smaller tissue graft. While I don't want a flap, I'm also scared about this happening again. Skin that has been radiated can act strangely (as in my case).

Has anyone had either an LD flap tell me their experience (positive or negative) or had reconstruction without a flap on a breast that had radiation therapy several years prior? I love to know how you've fared over time and your thoughts about my situation.

Thank you!

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Jun 18, 2019 09:21PM Mavericksmom wrote:

Hi Plite,

I had IDC in 2003, Lumpectomy, re-excision, chemo and rads.

December of 2018 I was diagnosed with ILC same breast. I had a mastectomy in January, with DIEP reconstruction and I am still having healing issues due to my skin being radiated in 2003.

I don't know that any of this is of help to you other than to say that I was told due to my radiation, I wasn't a candidate for implants.

I won't see the PA in plastics until mid July. I am not sure what he will say about my progress. My wounds certainly look better than they did at the end of April, which was the last time I was seen by him. I don't know if my wounds will ever fully heal and I need to discuss that with him.

I know others who have had radiation and had no issues healing, but I think I am just sensitive. My breast was bright red immediately after my lumpectomy and remained that way for years. I was severely burned by the radiation. I had jelly bean size blisters on top of my breast and the skin under my breast "sloughed" off. It did eventually heal, but my breast had lymphedema in it and a great deal of scar tissue. That was one of the biggest reasons I was shocked that I had a recurrence as I thought the pain I was feeling was from the lymphedema in the breast. I had my whole fat pad removed, 24 nodes and immediately got lymphedema in my left arm.

I am sorry I am not more helpful to you. I don't know if a LD flap would be better, but any reconstruction using your radiated skin could come with healing issues.

Hopefully someone else will jump in and offer advice.

Good luck to you. I hope you continue to post here!

Dx 6/6/2003, IDC, Left, 1cm, Stage IA, Grade 1, 0/24 nodes, ER+/PR+ Dx 12/4/2018, ILC, Left, 1cm, Grade 2, ER+/PR+, HER2- (FISH)
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Jun 19, 2019 09:59PM plite wrote:

Thank you Mavericksmom - I really appreciate that you shared your experience. I did not have as tough of an experience with radiation as you did (no blisters or sloughing - just a little red and swollen). However, radiation must have impaired my ability to heal when I went through the expander process and also when my implant was placed. I developed a hole both times and it timed with exercise and weight lifting again e.g. bench pressing. May or may not be a coincidence, but my guess is that the skin was stressed because it didn't stretch well. An ultrasound found normal scarring and nothing odd. It's not an easy road to navigate (breast reconstruction) when you've had radiation, especially when complications arise. I wish you all the best with your healing! Thank you again!!

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Jun 20, 2019 05:50PM macb04 wrote:

I had rads fibrosis, and still suceeded with Prepectoral Implant Reconstruction.

Topic: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES! Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.
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Jun 24, 2019 08:30PM plite wrote:

Thank you! How long ago did you have the reconstruction? I had the implant put directly under my skin (not pectoral muscle) because of the quality of the skin had looked good. I'm glad to read you did well!

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Jun 26, 2019 01:06AM macb04 wrote:

Last surgery was 2016. Had first a too small 420cc in Jan 2016, and then a 495cc still too small Implant put in March 2016. The PS screwed up cutting away too much skin when he used some wacky computer simulation to pick the 420cc implant. I had been expanded with the TE prior to that to 600cc, and that was only slighly bigger than my R real breast. I really should have had a 550cc or 575cc implant. He was only able to squeeze in the 495cc, which means that naked I am distressingly lopsided, so I never look anymore. My husband never sees me naked either. I am just worn out with the entire mess.

The only thing I will say, is at least the awful iron bra subpectoral sensation improved with the switch to Prepectoral Implant Reconstruction.

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Jun 26, 2019 07:50AM Bonnie7 wrote:

Hi Plite,

I had a LD flap on my radiated mastectomy side......I had radiotherapy in 2002, following a lumpectomy (r) side then had a radical mastectomy in 2005 same side. I waited exactly 10 years before I went ahead with LD surgery, the skin/area itself was not an issue and the end result was pretty good aesthetically. Unfortunately, I had a reoccurence in 2015, again right side, above implant, (stemming from 2002 as per pathology confirmation) so not a new cancer as such. I opted to have a deconstruction early 2017 following treatment (chemotherapy and hormone therapy) and have no regrets about that....but my biggest regret is having the LD surgery, I know there are many on this Site who have had LD surgery successfully and are happy but there are many that are not, I would personally 100% NOT recommend. I have chronic back and rib pain; having never had back pain previously (and I am a Nurse) I was 49kg and was told afterwards I should never been offered this type of recon - too lean and not enough padding!!!!! I honestly think the PS was keen to keep his skills up with this type of procedure!

Please look at other options.....

All the very best to you xxx

Dx 2002, DCIS, Right, Stage 0, Grade 1, ER+/PR+, HER2- Dx 2005, IDC, Right, 2cm, Stage IIIA, Grade 3, ER+/PR+, HER2- Dx 2016, IDC, Right, 2cm, Stage IIIB, Grade 3, ER+/PR+, HER2- Surgery Mastectomy Hormonal Therapy Aromasin (exemestane), Femara (letrozole) Surgery Lumpectomy Radiation Therapy Hormonal Therapy Chemotherapy Surgery Lymph node removal Hormonal Therapy Aromasin (exemestane) Surgery Reconstruction (right): Latissimus dorsi flap Surgery
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Jun 26, 2019 08:53AM plite wrote:

I'm sorry to read about your experience macb04. I am waiting until Spring 2020 for my next attempt with an expander and implant again. When things go wrong, it is wearing and demoralizing. I'm trying to focus on my health (and lose the weight I've gained while recovering from 6 surgeries). I'm in the process of mentally getting my groove back, which is a slow process right now. Thank you for your input and I wish you the best!

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Jun 26, 2019 08:59AM plite wrote:

Hi Bonnie7 - thank you for this information. I have read that there can be pulling along that region and I imagine nerve damage. I have a lot to think about! The doctor notes are to possibly try again without a flap but I'm scared of losing the implant again as the skin opened up with the expander and then again with the implant, the skin just super tight while healing. Since I'm waiting until Spring 2020 (maybe summer TBD), I have time to explore all possible solutions. I am at about 15 pounds over my ideal weight and plan to lose it by then. So I will be lean and not have a lot of tissue to use (DIEP and other parts have been removed as options already). I wish you the best and am sorry to read about the continuing pain and issues. Thank you again!

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Jul 3, 2019 12:03PM macb04 wrote:

plite, have you had any Fat Grafting to the radiated skin yet? Also used Pentoxifylline 400mg three times per day and Vitamin E 400IU per capsule three times per day. That made a large difference in the suppleness/stretchability of my skin. I also had Hyperbaric Oxygen Therapy for healing after the last several surgeries. I think all of that contributed to success.

Before that the Rads Fibrosis was tremendously difficult to deal with, my skin was stiff/thick and woody. Night and day difference in the texture and appearance of my skin.

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Sep 13, 2021 08:11AM plite wrote:

Just wanted to provide an update: I am now going through reconstruction again. Not with an LD flap. We’re trying the direct to expander option again. When talking with the PS, I may have had an infection that was never resolved. Apparently, cultures don’t always return a positive when there is an infection. It remains a mystery why it failed. That written, I’m going very slow this time with the expansion process. I want to make sure I have mobility back and my skin continues to look good after the normal healing point before I even start the expansion part. And I’m going with as small a size as possible (300 ml)

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Sep 15, 2021 08:21AM RMC19 wrote:

I was in your exact situation - cultures said nothing (2x), but went back to expander after wound vac and acid infusions. Expanded super slow. Exchanged on 4/2021 and everything was fine until July 2021 - infection again. Right now contemplating IV or just removing and going to DIEP Flap. I hope yours turns out better. Mine looked absolutely wonderful after the 2nd exchange and this popped up out of nowhere. I'm just not sure what to do now.

Dx 7/10/2019, LCIS/DCIS/ILC/IDC, Right, 3cm, Stage IIB, Grade 3, 3/21 nodes, ER+/PR+, HER2- (FISH)
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Sep 15, 2021 08:46AM plite wrote:

Wow! I don’t know what I’ll do if this fails. I may go flat chested. It can be such a hard process emotionally and physically. Right now I’m in week 4 of having my drain tube in which is a record for me (previously it’s was always out 2 weeks or less). That worries me because of risk of infection the longer it’s in but I’m still producing too much fluid.

Like you, my expander/implant issues happened well after the normal healing period. My white blood cell count was a little low before the latest surgery so the PS put me on antibiotics during and after surgery. He mentioned that it was probably good that I waited 2 years to try again because it can take that long for your body to resolve an infection.

I’m now wondering if I should wait 3 months before expanding to see if anything happens to that area with time. I’m not sure I want to start that process to just have it ultimately fail.

Please keep me posted if you’re willing. I’ll be thinking of you and would love to know how you fare

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