I have heard a lot about how reconstruction options can be restricted if you have had radiotherapy but not exactly what the restrictions are and why.
I am about to have rads after a wle and snb. The general look of my breast in a bra is ok but because the cancer was right under my nipple it was removed along with the areola and the breast now has a blunted look. I am hoping to have some fat transfer to both breasts to re-shape and plump them up a little, and also nipple reconstruction. I understand that that cannot happen until 6-12 months after rads. But can anyone tell me if I am being realistic in what cosmetic work I would like to have done?
I had bilateral WLE and rads, then wanted a bit of reduction on the left to even up Droopy and Perky. Having been told all throught treatment from DX onwards that this would be possible, if a bit difficult, after rads, I was then hit with the news, 18 months after rads, that ‘we don’t do reduction surgery on irradiated breast tissue’. I was devastated and had to agitate a lot to get an appt with a PS who would do the job - and it is fine.
Maybe you can have the corrective proceedures before rads, or maybe your clinic will do surgery after rads. It’s all about rads tissue not healing well etc whereas a recon op brings new tissue to the boob which has lots of good blood vessels etc.
Get VERY clear information from your clinic and WRITE IT DOWN WHEN THEY ARE TELLING YOU so there is no fudging at a later date.
Sorry, forgot to say - the fat transfer thing is OK after rads I believe cos they don’t actually cut the breast tissue. And yes, it is usual to wait 6 - 12 months to let evrything settle down. Keep your skin in good condition with massage and whatever moisturiser your clinic suggest eg aqueous cream.
Re: nipple recon, I had it done on my irradiated reconstructed breast quite successfully. Opinions vary between surgeons, mine used a tiny piece of skin and fat from my back to craft a nipple shape which she stitched on to good effect. Other surgeons will do t-flap or star-flap ‘origami’ nipple reconstructions on irradiated skin but mine was against that option for me. It may depend a bit on how much zapping it has had - mine got 25 zaps in each of three directions.
I know people who have had fat transfer done very successfully post rads. As Grumpy says, it is not really cutting the skin (just a little hole where they inject it) so is fine.
Hope you get a good result. Wait times can be horrendous for these procedures as they are non-urgent but worth it in the end.
I have already got the booklet about rads - however the message about surgery after rads is not very helpful. It’s the same message as I had from my clinic during and after treatment - surgery after rads is difficult but not impossible, and my clinic did NOT tell me until it was 2 years too late that they don’t do reduction surgery after rads. I have made a huge fuss about this lack of full information, and I just hope they are much clearer and upfront with ladies now.
It is a Catch 22 - we don’t do corrective surgery before rads cos rads can change things, and we don’t do it afterwards cos skin may not heal etc!!
None of this is a COMPLAINT about my treatment, rather a suggestion about how to improve the service…
Hi Mary, I also had WLEs x 2 and 15 sessions of rads last year. After recurrence this summer I have had a mastectomy with immediate LD flap and implant. My skin is fine, I did make sure during rads that I kept it really well moisturised with aqueous cream, before, during and after treatment. I was told that I would have been able to have DIEP recon too ( but my hospital doesn’t do it) but wouldn’t be suitable for expander implant because of rads. Hope this helps, Helen x
Just thought I’d report in - I had a small reduction to an irradiated boob earlier this year, and it has been absolutely fine, The scar is almost invisible now, the boob formerly known as Droopy is now Perky and matches the other side which is great. I didn’t need nipple recon, and the scar round the nipple is so faint that I reckon it’s near invisible. I think the outcome has been so good because I used lots of aqueous cream and Bio-oil while I had rads and ever since, so the skin had lots of massage to encourage good blood supply.
My reduction op was 2 years after rads.For the first year the clinic kept saying not yet, we’ll keep reviewing the situation. THEN I was told ‘we don’t do surgery to irradiated breast tissue, and I went ballistic. This had never been said before so I made a big fuss and got referred to a plastic surgeon who did the job. That took 6 months of putting on the pressure, and I had the op earlier this year. Yes it did take quite a long time to heal up properly, but 10 months on the scars are barely visible and everything matches up and looks ‘normal’ again. I don’t think the medics understand how appearance matters more to some women than others, and think if they keep fudging the issue, we will’come to terms’ with being lopsided or whatever.
The attitude of the medics seems to be keep the patient cheerful and don’t be too specific about lack of options. That really makes me mad - we are intelligent people and need all the correct information to make good decisions. For example maybe I could have delayed rads and had the reduction first: I didn’t need chemo so a 6 month wait for rads would have been just like everyone else.
But there you go, and I’m fair, fit and fine now, and just trusting that my clinic are upfront with patients now.
I had mx Dec2003, followed by chemo FEC x6, prescribed Arimidex, Rads x15. Rads was complete by end Aug 2004.
By then I think I’d had enough of hospitals to even think about reconstruction options, so I wore a prosthesis. I was ok with that until the next summer when I found wearing quite a large prosthesis C/D cup in hot weather was sweaty and uncomfortable. Time for a change…
I researched recon methods on the internet and decided I wanted to ask for a DIEP flap but wasn’t sure if it would be possible having had rads.
I WAS able to have it done, and was told it helped that I had moisturised the area with aqueus cream or Bio oil twice a day. Still do even now.
I went from a large C/small D cup to a B cup, and had my natural breast reduced to match, the following year. So my advice to anyone thinking of having recon after rads is to keep the area well moisturised, don’t give your skin chance to tighten too much.
Wishing you all a good recovery
Lesley x
Hi Gilly, In answer to your question how long after? My mx and recon was 9 months after rads. My skin has healed beautifully and 4 months on my scar is beginning to fade. The only problem I have had is with lingering fluid retention which I was told is a problem with irradiated skin but that is also now going. I think from what I learnt and what everyone else has said, moisturising well is essential, at least twice a day. And it also lessens the effects during rads, maybe some surgeons are reluctant to do corrective surgery on irradiated skin whereas a mx is classed as essential? However if surgery wasnt possible I wouldn’t have been offered an immediate recon and as mine has definitely worked I don’t see why anyone wanting any type of surgery shouldn’t get it. Helen
Just to update you all on how the reduction on irradiated breast has turned out - it’s now 2 years since the surgery and the scars have faded away almost completely, I have two matching boobs and I am so pleased I was pushy with the medics.
I am STILL very angry that no-one was completely upfront (sorry!) about rads making reduction surgery unlikely/ill-advised until AFTER I had all my rads. It was very naughty to allow me to believe the corrective surgery would be OK after all my treatment when the clinic knew all along that ‘we don’t don’t do reduction surgery to irradiated tissue’
I hope all clinics are now giving unambiguous guidance to patients - we are entitled to the full facts so we can make properly informed decisions.
This is a very interesting thread, I’m not sure if anyone other than Grumpy is out there? Butterfly/gilly I’d live to know how you got in with the expander and radio. I had immediate reconstruction with implant after mx but had to have it removed due to infection. Surgeon and I dud unused options yesterday, one is to have an expander 8 weeks after chemo has finished, then replace that with silicon after rads. Or might have to take some back muscle/ skin if niit enough of me left, but she seems confident we can do it after rads. Had so many problems first time round I’m anxious, but got minths to wait.
Would love to hear positive (and negative) stories about recon experiences.
The rationale seems to be that any surgery after rads is OK if new skin from somewhere else is used such as from your back. This is because the new skin has a good blood supply, whereas the irradiated skin will have a damaged blood supply and may not heal as effectively.
Unfortunately I was not told this until AFTER rads, it was always get over all your treatment then we will put things right. As all I needed was a small reduction and a bit of uplift after bilateral WLE left me very lopsided, to be told no chance of such surgery after rads was devastating. I made a big fuss and got referral to a plastic surgeon to get the job done, but I still believe I should have been given the option of this minor procedure before I embarked on rads.