Does radiation aftter lumpectomy changes the landscape of future treatment options?

[Lilliya]

Hello All,

I am 49, was diagnosed with DCIS (high grade, 3 cm) in rgt breast in October. The first lumpectomy surgery removed the DCIS, the second was done to achieve enough clear margin and resulted in removing only healthy tissue - in November. I was told I need radiation after. I was not explained that radiation may alter treatment or reconstructive options later on if (hope not!!) the DCIS or an invasive form of cancer returns or appears.

I just learned about the difficulties of using implants for reconstruction on a breast that was radiated before. I am upset, that no one mentioned this before hand, and hesitant how to proceed. Radiation should start beginning of January for 6 and 1/2 weeks. Please tell me your thoughts.

1. This is DCIS. should I opt for tamoxifen only and monitoring?
2. Should I decide on mastectomy and reconstruction as a prevention?
3. Should I still go for radiation hoping that the equipments are getting better each year and this won't cause a major problem in case mastectomy/reconstruction needed in the future?
4. Even with mastectomy the chances of having cancer later on in life is not zero. With an implant already in the breast monitoring seems to be more difficult. MRIs don't pick up the type of calcifications as mammogram machines do. My DCIS could have gone unnoticed in MRI.
5. Are there any PS-s specializing in implants after radiated breasts??

Thank you, and I wish well for every member of this list.

[Lilliya]

Thank you yapdip and SueYoung55! I appreciate your answers. I am trying to make an appointment with the head of plastic surgery at the local medschool to gather more information in addition to my PubMed research. Thank you for the name of the PS! I am seeing a medical oncologist tomorrow, and was planning on asking about chemo. One moment it is "only DCIS" then I think about that it is third grade with necrosis... Difficult to come to a conclusion. I did not know either that you can be radiated only once.
Good day!

[SueYoung55]

The reconstruction expert forum is closed for now and all posts are being transferred to the cosmetic surgery forum.

I've had bilateral mastectomies and radiation and DIEP perforator flap reconstruction in New Orleans with Dr. Frank DellaCroce. Tissue transfer can take place prior to radiation, just so you know. I would actually do it at the same time as the mastectomy and since they use tummy or butt tissue (no muscle is moved in DIEP) it tolerates radiation beautifully.

Expanders/Implants would NOT be a choice I would make. Please consult with a few plastic surgeons and you will find out that radiated skin doesn't stretch after radiation and capsular contraction is likely, failure rate of between 70 & 90%. Then there are the few women who have had successful implants after radiation. Get informed and make a decision you can live with, no regrets.

I would choose chemo and rads with DCIS. I know you are probably thinking I'm crazy for suggesting that but there are many studies out there that show that agressive treatment up front gives better results over time. Research research research!

Tram flap and lat flap surgeries are offered by most plastic surgeons. Both involve moving muscles. DIEP is performed by teams of micro surgeons with no muscles moved. I travelled from Florida to New Orleans to get mine done by surgeons who do approx. 700 of these surgeries a year and have been for about 10 years. I would not let just anyone who says they can do this perform this surgery. Again, research and meet people who've used your choice of surgeon, see their results in person.

Best wishes.

[japdip]

I know there are many women who have had Radiation and reconstruction as well. There is of course always the matter of healing that may be compromised. If I were you I would search for a Plastic Surgeon and have a consult regarding the possibilities in the future before beginning Radiation.  you might also post your concerns on the Expert Forum "Reconstructive Surgery" where a plastic Surgeon answers questions and concerns.   Good Luck ......