Reconstruction and Radiation

Westcoastgirl · 02-20-2009, 11:23 AM

Hello ladies,
I begin my chemo on Monday. In a weird way it feels good to be getting on with the treatment although I am very frightened. I have all the meds and different items suggested on hand for the big day. At my visit with the Onc he said I could begin reconstruction when I am on Herceptin alone. I wrote to my ps and he said I could not begin reconstruction until the portacath had been removed....sigh. I want to have silicone implants as I do not believe I want to cut any other part of my body and anyhow being quite slim I am certain they could not find enough flesh to create two breast mounds. The Onc said the protocal was to take all my nodes but the surgeon decided to take only 8 which were all negative. Both the Onc and surgeon do not believe I need to do anything more but I am being sent to the Rad.Onc to see if he feels I need to do radiation. My question is will radiation interfere with reconstruction? Thanks, Carolyn

Soccermom · 02-20-2009, 12:30 PM

Carolyn,
first let me just say,"you CAN do this"! Chemo can be tough but we are tougher!!!
Yes, I do know that radiation can affect the skin and the implant. This is from the breastrecon .com... ( I did not have rads )...

"

For patients with a tissue expander in place, radiation will affect the quality of the breast skin overlying the expander. The skin may recover enough to allow exchange of the expander for a final implant. If the skin does not sufficiently recover, or if other problems arise, it may be necessary to salvage the reconstruction with the use of a flap. One alternative is to utilize a latissimus dorsi flap while retaining the implant as part of the reconstruction. The other alternative is to abandon the implant reconstruction altogether, and to proceed with an autogenous flap alone, such as TRAM flap or an abdominal microvascular free flap.
For patients with an autogenous flap reconstruction that is then radiated, the quality of the skin will be affected and the risk of fat necrosis within the flap will be higher. Should fat necrosis develop, an area of the reconstructed breast may become firm. Sometimes this prompts evaluation with an ultrasound or MRI. If needed, a biopsy may be done to confirm the diagnosis of fat necrosis in the flap. Usually, the firmness associated with fat necrosis will soften over time."

My PS (microsurgeon, I had stacked DIEP flap) removed my port during stage 1 of my reconstruction.

I hope this information is helpful

karen z · 02-21-2009, 10:51 AM

Carolyn,
I can only speak to the chemo/herceptin part of your treatment. I, too, was very afraid to do chemo. In fact, once I was in the room, I turned and tried to go in the other direction- to the head nurse's office. My friends and the head nurse got me going in the right direction again and I did it. It is not fun but is something YOU CAN DO. Have someone there with you always to make the time go by and give you emotional support (I had one friend who tried to teach me to knit during this time. We would start off knitting but I usually fell asleep- then she would continue to knit- I wasn't the best student). Take the meds prescribed as the nurse's say- it is easier to prevent nausea than reverse it. The drugs around now do an amazing job with the nausea. More surprising to me was the fatigue I would experience at certain points in the cycle. After one or two cycles you will know how you are going to feel and when. I PROMISE THAT YOU CAN DO THIS AND THAT THE TIME WILL GO BY. KEEP YOUR SITES ON THE DATE WHEN IT IS OVER AND KNOW THAT EACH DAY GETS YOU CLOSER TO THAT POINT.

Best,
Karen

Laurel · 02-21-2009, 09:04 PM

Good luck on Monday, Westcoastgirl! We are all pulling for you! Chemo is just yukky, but you will be done before you know it. I will pray all goes well for you. Let us know how it goes when you are feeling improved.

Jackie07 · 02-21-2009, 09:35 PM

Try finish your meal at least 2 hours before the treatment. They may give you some ice to chew on during certain chemo infusion. Be sure to let the technician know your reaction to the chemo. Get a book to read or a puzzle to do. Our treatment room also has small TV mounted individually.

I usually fell asleep after 1 1/2 hour infusion. Also, your first infusion (loading dose) will be much longer than the following ones. (1 1/2 vs. 1/2 hour) I think the total treatment takes about 2 hours thereafter. Because I had had certain reactions (rash? &?), I had to take about 4-6 pills (including benadryl) orally just before getting the intravenous treatment. (They also do a 'flush' of the chemo pouch before infusing the real chemo liquid.

Just be sure to communicate to your nurses and treatment room staff.

Becky · 02-22-2009, 06:34 AM

Hi

Although I did not have my breasts removed, I am seriously contemplating it and have researched reconstruction and gone to seminars.

I am not interested in implants but from my research, if you get radiation and the rads are done before the reconstruction then nipples cannot be made from the skin that was radiated and they use skin from the inside of your thigh. Also, radiated skin may not stretch as easily as skin that is not radiated. However, if done before rads, you could get some capsulation (odds are well in your favor that this would not happen). Are you getting the new "gummy bear" silicone implants. Ask your PS about them because I heard in a recent seminar that they are superior and they should be getting FDA approval as we speak.

You should also ask your PS about the pros and cons of reconstruction before or after rads as they would have the best perspective of this.