Implants vs. tram flap post bilateral mastectomy

[Rosa]

I am a breast cancer survivor.  I was first diagnosed in May of 2000 at which time I had a lumpectomy in my left breast followed by chemotherapy and radiation for stage 2B.  Now I have been diagnosed with DCIS in the same breast and have opted for a bilateral mastectomy with immediate reconstruction.  I would like to have bilateral implants and avoid the major surgery of the tram flap, however my plastic surgeon told me that sometimes the skin on the radiated breast does not stretch sufficiently to accomodate the implant although she did not rule it out either.

I am so confused!! - I don't know what to do.  Can you please help me.  I don't wish to have large breasts, but on the other hand, if I have to go through this again, I want to have the procedure that can guarantee me the best cosmetic result.  Some information from the internet has led me to believe that this is nearly impossible with implants once the breast skin has been radiated.  I do intend to discuss this again with my plastic surgeon.  My surgery is set for Dec. 9.

If there is anyone out there who has had radiation to their breast prior to impants for a previous occurrence, please help me by sharing your experiences.  I would like to hear both success stories and those not so successful.  I would also like to hear from those who have had a tram flap.  

In closing, I am not a heavy person, therefore to perform the tram on both sides would not be possible. It was mentioned that I could have a tram and implant combination.  I just would like to avoid all of that surgery.  Thank you

[Rosa]

Thank you so much for your kind response.  I have made the decision to have the bilateral mastectomy with expanders and ultimately silicone implants.  I have thought this over very carefully and feel that this is the right thing for me.

I am comfortable with the decision I have made and look forward to my surgery date as a new beginning.  

[thewas]

I did not have radiation.  I first had my right breast removed due to cancer.  Then the left breast was removed 6 months later as a preventative measure.

I had a little of each.  First, my plastic surgeon put in tissue expanders and I went once weekly for saline injections.  Unfortunately, because there wasn't enough skin, tissue, and muscle left in my right breast, the muscle & skin split open.  I had to have the expander removed.

Three months later I had surgery again.  The left tissue expander was exchanged for a saline gel implant.  That breast looks absolutely wonderful!  I had a Tram Flap done on the right side, with a saline implant.  That doesn't look so good.  As it turns out, the plastic surgeon didn't make a large enough pocket and the implant floated upward.  The tram flap itself was done too far to the right.  I will be having corrective surgery in March.

I would suggest a 2nd opinion.  In my case, I had to have the flap done on the right side...no choice.  But in restrospect, if I had a choice, i would have gone gel implant on both sides.

[CCF-RN,MSN-rf]

Dear Rosa on Sunday:  Plastic surgery is as much an art as a science.  Each person and surgeon will have some variation as to what can and cannot be done.  While it is theoretically possible to use an expander and implant in skin that has been radiated, there are also potential problems that can arise.  Each person's skin also reacts a little differently to the radiation, making results variable.  Tram flaps also have their own pro's and con's.  Our recommendation is that you get a couple of opinions from plastic surgeons who do large volumes of similar surgery.  Discuss the pros and cons of each scenario as they relate to you, your skin, your size, etc.  Only with specific data will you be able to make a good decision.  Also, as the doctor to talk with some patients who have been through both procedures.