Breast Reconstruction after previous Radiotherapy
Here is a recent question I answered on breast reconstruction for a patient who had previously had a lumpectomy and radiotherapy.
The question was:
Hi, I am 38 years old and have just been diagnosed with a second breast cancer. It has been 9,5 years since my first operation. I had a lumpectomy and 12 nodes taken. The cancer was confined and I had radiotherapy. Yesterday I was given the great news that the cancer has not gone elsewhere, but need to operate. I have since had a family history of breast and ovarian cancer. The Doctor is talking mastectomy,and I am happy for that but concerned they may not be able to do reconstruction as I am very slim and have no excess fat or tissue. What are the options? I see the Specialist and Plastic surgeon next week but would love to know more now. Could I just have the cancer removed, another lumpectomy? would that alter the chance of the cancer returning again
And my reply was:
Dear Nerida,
I’m sorry to hear that you need to deal with breast cancer a second time.
As you have already had a lumpectomy and radiotherapy, another lumpectomy is not really an option, and you will most likely need a mastectomy.
In terms of the timing of reconstruction, if you breast surgeon can co-ordinated things with a plastic surgeon, you may be able to have an immediate reconstruction – where you breast reconstruction happens at the same time as your mastectomy.
There are a few options in terms of reconstructing your breast. If you are slim, taking tissue from the tummy may not be an option. There may be other places to get tissue from – ad your plastic surgeon will look at those.
Taking tissue (skin and muscle) from the back (the latissimus dorsi muscle) is a good alternative, although you would need some sort of breast implant to make a decent size breast in most patients. I wouldn’t recommend using an implant just on its own (ie without covering it with muscle from the back) as there is a high risk of wound healing problems and infection when an implant is place underneath skin which has had radiotherapy.
Symmetry could be a problem, especially if your other breast is saggy. It’s sometimes hard to get a breast with an implant to sag naturally, even if you cover it with a flap from the back. I have had patients who underwent a breast augmentation on the other (normal) side – it’s easier to match a reconstructed breast which has an implant with a natural breast which also has an implant.
Good luck with everything!
Kind regards,
Damian
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I am a plastic surgeon who performs breast reconstruction, breast reduction and breast augmentation surgery for patients through the Kogarah, Sutherland Shire and greater Sydney area.
