HonCode

Go Back   HER2 Support Group Forums > Articles of Interest
Register Gallery FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools Display Modes
Old 11-26-2013, 10:59 AM   #1
'lizbeth
Senior Member
 
'lizbeth's Avatar
 
Join Date: Apr 2008
Location: Sunny San Diego
Posts: 2,214
Post Breast Reconstruction After Radiation

Breast Reconstruction After Radiation


by: Brandy Korman
Traditionally general surgeons and oncologists have advocated waiting 6 months or more to have breast reconstruction after radiation treatment. I’m sure that those of you have needed radiation in the past have been told this, and even now, some surgeons and oncologists are still recommending waiting this long.
So it may come as a surprise that the surgeons at PRMA, in most cases, are only recommending waiting 4-8 weeks.
To get the scoop, I chatted with one of our surgeons, Dr. Steven Pisano who had this to say:
“We’ve found that performing flap reconstruction sooner rather than later is actually better for the patient. Doing reconstruction sooner improves the environment of the chest wall by allowing for increased blood flow, in turn creating a healthier breast.
With radiation, the patient’s skin and soft tissues are ultimately damaged. The longer the patient waits to have reconstruction, the longer the effects of radiation have to settle in and wreak havoc on the skin, tissue and surrounding areas.
Performing a flap procedure like the DIEP, LAT or GAP flap allows us to remove that radiated skin and tissue and replace it with healthy skin and tissue from another part of the body.”
Implant procedures, however, are not recommended at all for patients undergoing radiation treatment. If you’re a patient potentially needing radiation treatment, Dr. Pisano recommends a flap procedure if you are a candidate for one.
"We avoid implant reconstructions in the setting of radiation, due to the increased potential for short and long-term problems such as infection, wound healing problems, capsular contracture and poor aesthetic outcomes."
For more information on breast reconstruction after radiation, call 800.692.5565 or email patientadvocate@prmaplasticsurgery.com.
'lizbeth is offline   Reply With Quote
Old 11-26-2013, 11:17 AM   #2
Shirley
Senior Member
 
Shirley's Avatar
 
Join Date: Apr 2013
Location: Lakewood, WA
Posts: 56
Re: Breast Reconstruction After Radiation

Thank you for that post, 'lizbeth. I am just finishing up radiation (worst experience so far, BTW). My ps said 12 months for a flap surgery and something like 4-6 months if the skin can handle an implant. I prefer a DIEP flap if it's possible, although I'm getting awfully tired of the expander (it looks and feels wierd and I'm lopsided because the expander sits up higher. I guess I should just be glad that I'm alive and not fret over this). He said he would consider an implant, but another ps said "studies show that waiting 12 months for a DIEP is better than waiting 6-9 months, and we do not do implants on radiated skin".

Of course at this point, at the tail end of radiation, any sort of surgery involving the radiated site sounds preposterous. I can barely move that arm and am in constant pain. Aargh!

Shirley
__________________
  • Age 54 at dx (April '13) Stage 2b, grade 3
  • ER+ PR+ HER+, 9 cm tumor one breast and <0.5 cm in sentinal node
  • BRCA1 and 2 negative
  • Neoadjuvant TCH chemo started 5-15-13 (4 rounds, 3 weeks apart)
  • Unilateral Mx w/expander 8-22-13 (right side)
  • 5/5 nodes Neg
  • clear margins but close. Tumor at removal down to 2.2 cm.
  • Radiation 6 wks starting 10-17-13.
  • Herceptin every 3 weeks until 4-23-14
  • DIEP/Mastopexy 10-8-14, U of WA
Shirley is offline   Reply With Quote
Old 11-26-2013, 01:47 PM   #3
jaykay
Senior Member
 
Join Date: Oct 2012
Posts: 625
Re: Breast Reconstruction After Radiation

Yes, the expanders are a royal pain (pun intended). I finished radiation the end of May, 2013 and the radiation oncologist wanted me to wait 6 months until I went through the exchange surgery with implants. I had no intention of going through anything more involved than silicone.

Anyway, I went to see my plastic surgeon about 3 months after radiation and she would have done the exchange immediately but I had overseas travel planned and we decided to wait until I returned - which happened to be 5 months after radiation ended. Everything is fine so far, may have to have a little fat injections (yea for lipo!) once they "settle".

We did not know that I would need radiation when I did the bmx and tissue expanders. I still would not have chosen any kind of flap procedure, but that's me. Everyone is different.

Best
Janis
__________________
March, 2000: 48, Post menopausal (5 yrs HRT) Left breast, IDC 3mm/DCIS 1.6cm, ER+/PR-/Her2+++, mod differentiated, MIB low, lumpectomy, node neg via SNB, rads=33 Stage 1a
June, 2000: Tamox 4.5 years,Femara for 5 years (end in Jan. 2010)
Sept, 2012: 61, Via mamm, ultrasound, biopsy, right breast, 2.3cm tumor, ER+/PR-/Her2+++, poorly diff, KI67 60-70%
BRCA 1 and 2 negative
October, 2012: Bi Mast with tissue expanders, port placement
Final Path: IDC 2.8cm, DCIS, 1/4 sentinal nodes positive (@#$%). Stage IIB
Nov 29, 2012: Begin TCH/6x/every 3 wks, H for 1 year/every 3 weeks.
March 14, 2013: Finished chemo
April 9, 2013: Begin radiation 28x
May 22, 2013: Finished rads
June 1st, 2013: Started Aromasin for 5 yrs.
July 15, 2013: Switched to Letrozole (Femara). Probably for the rest of my life
October 16, 2013: Exchange surgery
October 31, 2013: Finished Herceptin
December 5, 2013: Port removed
Glad this year is over!
jaykay is offline   Reply With Quote
Old 12-08-2013, 02:12 PM   #4
JJ201349!
Member
 
Join Date: Jul 2013
Posts: 19
Re: Breast Reconstruction After Radiation

Dear Shirley,
I am scheduled to start radiation late January or early February after my 4 months of chemo (except Herceptin, which I will continue until August). What was the worst part of radiation, any advice?

JJ
JJ201349! is offline   Reply With Quote
Old 12-09-2013, 12:38 PM   #5
Shirley
Senior Member
 
Shirley's Avatar
 
Join Date: Apr 2013
Location: Lakewood, WA
Posts: 56
Re: Breast Reconstruction After Radiation

Hey JJ,

Well, I posted a very detailed response which appears to have been lost due to timing out. Shoot!

I want to start off by saying that every person is probably going to respond to radiation differently. In my case it started out badly because of excessive wait times (30 minutes to an hour each day) and problems with their computer or network which would crash halfway through each treatment. There were days I was lying on that table in tears because my arms hurt so much from holding them back my head for so long. I had problems with pain in my lungs about a week after rads started and the docs were of no help and gave me conflicting answers.

So I called my nurse navigator, and she quickly got me set up with a different clinic in town. Yay! Same radiation company, but different location made all the difference in the world! No more waits, no more computer crashes...it went much more smoothly from there on out. My new Radiation Oncologist is female and explained that the pressure/pain in my chest was probably due to anxiety. I didn't believe here, but it went away so she was probably right (even so, my oncologist ordered a chest xray which came back clear).

What you might expect: you'll start out with a CT setup where they will map the area to be radiated and place tiny tattoo marks. I can't see my tattoos and they barely hurt so don't worry about that part. Then you'll wait a few days for them to write the computer program they will use to administer each day's treatment. They will also show you what the routine will be each day, as far as arriving, going to the dressing room, etc.

Each day you will come in and the radiation therapists will get you set up on the table and shift you around so that you are in just the right position. Then they leave the room to administer the treatment on their computers. You have to lie with your arms up behind your head and some "plates" move around you to take images and to administer the radiation. You will not feel the radiation, and will probably only be aware of it because it makes a buzzing sound. That whole thing (laying on the table, getting set up and then the treatment) takes about 15 minutes if it goes smoothly. Which it should.

I was using emu oil and Aquaphor on the radiated areas. They will get slightly red within a week or two, and then by week 4 or 5 I was really burned and it was painful--much worse than a sunburn. I was given Silvadene creme, but it was so painful I could barely touch the area. The Silvadene did make it feel better, however. The treatment even caused some burning on my back, but not to the point that it hurt.

But guess what? It has healed up very quickly and I feel fine. It's still red looking, but I just stopped last week so I expect that. But it doesn't hurt under my arm like it did, and the skin is much better.

I even got a certificate of completion and a coffee mug at the end! Yay I'm done with that!

One thing I'd recommend is adding aloe vera gel. I never got around to using that but have heard good things about it. Remember that it will get better.

Shirley
__________________
  • Age 54 at dx (April '13) Stage 2b, grade 3
  • ER+ PR+ HER+, 9 cm tumor one breast and <0.5 cm in sentinal node
  • BRCA1 and 2 negative
  • Neoadjuvant TCH chemo started 5-15-13 (4 rounds, 3 weeks apart)
  • Unilateral Mx w/expander 8-22-13 (right side)
  • 5/5 nodes Neg
  • clear margins but close. Tumor at removal down to 2.2 cm.
  • Radiation 6 wks starting 10-17-13.
  • Herceptin every 3 weeks until 4-23-14
  • DIEP/Mastopexy 10-8-14, U of WA
Shirley is offline   Reply With Quote
Old 12-11-2013, 03:28 PM   #6
JJ201349!
Member
 
Join Date: Jul 2013
Posts: 19
Re: Breast Reconstruction After Radiation

Hi Shirley,

Thank you! This is very helpful. Looks like reconstruction with expanders/implants can be challenging after radiation due to loss of elasticity (fibrosis). I think that I would like to discuss DIEP as an option for reconstruction. However, since it's a major surgery, the possibility of complications are higher.

Good luck and many blessings,
JJ
JJ201349! is offline   Reply With Quote
Old 12-13-2013, 05:41 PM   #7
kimsmo
Member
 
kimsmo's Avatar
 
Join Date: Dec 2013
Posts: 17
Thumbs up Re: Breast Reconstruction After Radiation

I had a double mastectomy in January this year, and expanders were inserted at that time. Unfortunately, the margins weren't very clear, so the docs decided I would need radiation (which we initially thought wouldn't be necessary).

After five months of chemo, I had 30 radiation treatments. I very liberally used the special radiation-specific lotion recommended by my doc, and tolerated it very well. It was much better than chemo, by far. I did have a very red "sunburn" by the end of radiation, but it faded nicely after a few weeks.

About a month after completing radiation, my implants were inserted, almost a month ago. The incisions are healing nicely and everything is looking good. The radiated side is a little firmer, and I've been advised to massage it daily to help maintain the pocket and keep scar tissue to a minimum. So far, so good!

I just have another five months of Herceptin treatments, then I'll be set loose with just Tamoxifen. Can't wait!
kimsmo is offline   Reply With Quote
Old 12-15-2013, 11:27 AM   #8
JillaryJill
Senior Member
 
JillaryJill's Avatar
 
Join Date: Aug 2011
Posts: 271
Re: Breast Reconstruction After Radiation

I had bilateral mastectomy, tissue expanders placed at that time (tissue expanders were one of the worst experiences of all the breast cancer procedures I had) I never got used to the hard feelign of those expanders and the saline fills to stretch the skin were painful. I had alot of radiation to a large field on my chest. I am of German/Irish descent with very pale skin. My silicone replacement surgery went fine. My surgeon did do some fat injections (lipo from my stomach and I was very bruised from this) and he also used a product called Alloderm which you can google. I did not elect to have nipple surgery or tatoo, by then I had enough of doctors and surgeons. I live on a lake and I am in a bathing suit often, and the result is good. I have a nice shape in clothes. My radiation side is tighter, but I did massage and used alot of coconut oil to keep the skin soft. My result is excellent. There was an argument between my radiation oncologist and my plastic surgeon (lots of Ego's) about the amount of saline in the expanders at the time of radiation. My regular onc had to mediate. The plastic surgeon said I could have full fill in the expanders, my radiation onc wanted some of the fill taken out. She won the battle. Once radiation was complete, I continued with more fills.
__________________
DX November 2010
Brain MRI, CT of lung, liver, bone, all clear
Double Mastectomy w/expanders December 1, 2010
ER- PR- Her2+++, grade 3, 12 positive nodes out of 15
Stage IIIc
Started TCH/Chemo December 31, 2010
6 rounds TCH
Herceptin every 3 weeks for a year
33 rounds of TomoTube radiation, to chest wall, neck, skin and lymph area
September, 2011, MRI to lower spine, hips, DX bulging disk, L4 & L5, pain not from cancer
Expanders removed, implants in Dec 1, 2011
Finished Herceptin, December 21, 2011
August 2012, CT of chest and abdomen, all ok
Enrolled in MC1136 Phase I Peptide Vaccine Trial at Mayo Clinic, Rochester, Minnesota
March 2013, First Vaccine
April 2013, 2nd Vaccine
May 2013, 3rd Vaccine
June 2013, 4th Vaccine
July 2013, 5th Vaccine
August 2013, 6th Vaccine Done!
September 2013, Mayo visit, Echo results 68, vaccine did not effect my heart! Blood work normal.
January 31, 2013, Mayo visit, Echo normal
February 23, 2014, Numb lips on right side, Brain MRI, normal!
June, 2015, Finished the trial at Mayo Clinic. Feels good!
JillaryJill is offline   Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is On

Forum Jump


All times are GMT -7. The time now is 10:37 AM.


Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2019, vBulletin Solutions, Inc.
Copyright HER2 Support Group 2007
free webpage hit counter