Reconstruction Options

[Sagebrush16]

What reconstruction methods are available to a woman who doesn't want to affect her muscles, doesn't want an implant, and has radiation to a breast with a lumpectomy? My breast looks good except for two jagged scars and a very light tan from radiation.

I want to have my normal size back because then I'll have my normal proportions. My unaffected breast may be lifted to match. I heal very well and had much less than normal burning during radiation. I have never had an infection related to surgery.

I am a single mom with lots of responsibilities no one else will do if I'm not able to do them, so six months recovery is not an option. Although I have a little tummy now, I normally don't and am on my way to returning to my normal, low, very slender weight. I want to get thin before I get the reconstruction so that the results won't be a surprise.

I am forty-nine. When I was on tamoxifen, my unaffected breast was smaller, so I want to have a result that won't be too wonky when I reach menopause and my unaffected breast becomes a little deflated.

Also, I'd like my two scars on my affected breast to be straightened and the scar tissue that makes that breast pucker noticeably when I flex my chest to be released. But, some professionals say that operating on radiated tissue is not a good idea.

I want my normal proportions back. That is not vanity as one surgeon told me. It's part of recovery and leaving cancer behind. I'm three years out so far.

[Sagebrush16]

First, thank you so much for taking the time to answer my question. Going to various doctors who have different training and prejudice can make reconstruction options challenging. I understand that there are many variables that would be difficult to assess via a posting such as mine. Let me rephrase the question:

For someone with a lumpectomy resulting in a very nice looking, but smaller, breast, whose tissue suffered little obvious damage (just a very light remaining tan) and who heals very, very well presumably due in part to excellent health habits, what are the options for enlarging that well-shaped but smaller and irradiated breast?

Can I consider a DIEP for this? I have an intact nipple and the shape is very good. I simply need more volume to match my unaffected breast and a lift for the unaffected breast. I want to get as close as possible to the way I was before, and I'm not interested in an implant due to encapsulation risks and future surgeries to replace an aging implant. I understand that an exam would need to be performed to determine my suitability in terms of my blood vessels and so forth.

1) Is a DIEP or similar procedure not involving muscles an option for some lumpectomy patients?
2) Can you stretch radiated skin sufficiently to add that extra volume to equal perhaps two cup sizes?
3) Do you have to use the skin from the abdomen when you do the procedure or can the tissue be used for volume only?

I understand that perhaps most surgeons are not trained or experienced with the DIEP procedures. I am simply looking for the best option for me and will find a way to travel to get it.

[Cleveland Clinic]

Dear Sagebrush16:  You would be best served by discussing (and being evaluated) by a plastic surgeon who is expert in breast reconstruction.  Without looking at the tissue and considering your desired outcome, it is impossible to comment on what the options might or might not be.  Even a very good plastic surgeon may not be able to make things look exactly as they were before, particularly if you are not interested in any muscle manipulation or implants.  However, an expert can give you a better idea of what you might be able to expect once he see's what he has to work with.