American Society of Plastic Surgeons
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samiam
11 months ago
Answered

Breast cancer double mastectomy results

I have had implants put in and taken out twice, the last time they took them out I had a staph infection. The surgeon said that nothing could be done to my right breast to loosen up the hardness, puckering and pressure due to the fact that I had radiation on that side. My only choice is to wait at least 6 months and then I would have to have skin taken from another area of my body. Help?

Procedure: Breast Implant Removal
Location: phoenix, AZ

Replies 7

Carlos Quintero
ASPS Int. Surgeon

Hello, radiation therapy often produces changes in the tissues like the shown in the picture.

I would recommend the reconstruction with the placement of a tissue expander ( round) underneath healthy tissue from your back ( muscle and skin), after the expansion, exchange for a permanent implant.

Tissue from the back of your chest is used often in my practice and any of my patients has a functional deficit. Proper blood supply to the muscle should be documented before the surgery or use an other method of reconstruction.

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Armando Donati
ASPS Int. Surgeon
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Hello! In these cases it is always better to evaluate your case in person to take into account the state of your skin and fat-producing areas. The surgical option that I suggest if possible to help your skin recover is to perform fat transfer in the irradiated chest in order to improve the quality and elasticity of the tissue. This may require several sessions every 3-6 months. Once the expected result is achieved, plan a reconstruction with mesh and the silicone implant. It is a process that can last between 1-2 years until the last intervention. It would be good for you to consult with a certified surgeon who performs this procedure and has a similar conduct. I hope it helps.

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Rahul Vemula
ASPS Surgeon
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Thank you for your question. Very sorry to hear that you experienced this

Radiation damages, the microscopic blood vessels in tissue. Once you fail an implant based reconstruction after radiation, another implant based reconstruction without some sort of flap coverage such as the latissimus flap or DIEP flap should not be attempted.

I agree with your surgeon. Wait 6 months. Then restart reconstruction with a flap: Latissimus flap + tissue expander, or DIEP flap

Given your radiation, if you attempt to do an implant based reconstruction only the failure rate approaches 80%

Best wishes.

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Andrew Kornstein
ASPS Surgeon

I would offer a different approach—- adipose stem cells(from your own body fat) to rehabilitate the tissue quality after radiation therapy

I do this routinely with success.

Q: Why were your implants removed the first time??

I believe you can avoid scarring in another(donor) site with this approach.

You may also have the option of an all fat grafting reconstruction.

Best

AK

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samiam

How many surgeries would be needed?

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Alfred Antonetti
ASPS Surgeon

You had radiation treatments to treat a condition and save your life. There are side effects from the radiation and your tissues are damaged from this and this is a very common problem. This is the reason you had problems. The doctor told you right when they said to wait at least 6 months. It may take even longer before anything should be done. There are ways to reconstruct this that use your own tissues. You are going to get many different answers from a lot of surgeons that have not had the privilege of obtaining a complete history and physical exam on you and this is not going to help you. You need to discuss all of this with your board certified plastic surgeon and if you are not satisfied then seek another opinion from another ABPS certified or eligible plastic surgeon close to your home. To be fair to you this needs to be done in person.

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Tanongsak Panyawirunroj
ASPS Int. Surgeon
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Sorry to hear your past experienced like that. Radiation damaged your cancer cell also normal breast tissue and small blood circulation cause tissue hardening and scaring that infection and complication easily happened. I recomended you to improve tissue and circulation quality by autologous fat stemcell or mesenchymal stemcell injection by fat grafting before deciding to do further step operation.

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