Reconstruction after radiation

[thehighprincess]

I had a mastectomy with insertion of a tissue expander last July for IDC.  The follow up appointment for reconstruction is looming but now I am having radiation which wasn't anticipated at the time of surgery.  How long should I postpone the appointment with the surgeon for while I recover from radiation?  Staff at the doctors office expect me to provide this information rather than other way around.

[katarina777]

I don't think the idea is for you to schedule a surgical date, but rather a date to come in and discuss matters, including a date for the surgery.

BTW, your comment back to SueYoung55 is really snotty and arrogant and mean. You can be grateful that she is willing to tell you what she thinks, and thereby does not do the 'standard safe ground deal' that the experts are doing, and avoiding all and every bit of advice, and which also means to the patient asking 'no answers, opinions, or help'.

We have been in the fold long enough that we know stuff that no professional will tell you. (we have been there, talked to hundreds of people who have shared with us, we know the other side)

I have listened to more women than you can guess who had horrible, disabling breast reconstructions that left them in tears and totally hopeless. their doctors, after messing up, are no longer interested in you.

Mow you can figure out your own timings if this is too much of an issue for you perfect doctors to do.

Kat

[thehighprincess]

"Radiation and expanders/implants are never a good combination" seems a strong comment for someone with no medical training.  My breast surgeon, who has a lot of expertise and training in this area, seems to think it is possible.  At the time of the original surgery, with follow up therapies in mind, the tissue expander was inserted and then filled before chemotherapy began.  There will be no expanding irradiated skin.  All options for reconstruction were discussed before the mastectomy, including procedures not performed by my surgeon.  I also researched the topic independantly.  We both decided that given my age and size flap reconstruction wasn't an option and that implants were the best way to go.  

What wasn't discussed was the time required to wait between radiation and surgery, as the opinion of the oncologist at the time was that radiation wouldn't be required.  So now I need to change my surgical appt to make time for radiation.  The surgeon has a very long waiting list and his staff just want me to name a date so that I have an appointment.  

My problem / question relates simply to timing.  If I wait until I see the radiation oncologist or complete radiation to make the surgical appointment then I join the looong waiting list.  If  I guess and make the appt it will probably be too early.  The sooner the tissue expander comes out the better.

I'm sorry if I gave the impression I was getting anything but the best medical care.  That was not my intention.  No one is hiding anything.  There are no conspiracy theories.  I'm simply impatient for this to be over and wish to expediate the process where ever possible.

[SueYoung55]

I agree with Katrin.

Radiation and expanders/implants are never a good combination. Radiated skin doesn't stretch anymore and radiation weakens the rib cage where it was radiated so instead of an expander pushing your skin outward it could push your ribcage inwards. Take a look at DIEP flap reconstruction which uses your own tissue without moving muscles. Great results can be had with an expert DIEP team. If your doctor doesn't do the surgery (which is microsurgery) they won't offer it so get the best available. I flew to New Orleans for mine and am thrilled with the results. They may offer TRAM which does move muscles and therefore not the best choice.

I'd be very leary of any physician who expects you to come up with all the answers. That said, you should always research everything before you make any medical decisions. You are your own best advocate.

Also, I had to wait a minimum of 7 months for my reconstruction due to my radiation. Give your body time to heal, it's been through a LOT.

Best wishes and best of luck.

[katarina777]

That is ridiculous, and unacceptable, thehighprincess. You need to have your radiation oncologist, but even more so the plastic surgeon advise you about these issues.

I am wondering if maybe you need to find out if things have changed now because you had Radiation vs. only delaying the surgery. i don't know the details but sometimes radiation makes it inadvisable to have reconstruction, or at least for a pretty long time. (I do not know the details but the way you are being responded to makes me wonder if they have something to hide from you/)

You need to confront these physicians! best of luck, Katrin

[Cleveland Clinic]

Dear thehighprincess:  This is not information you or we can provide.  This is a discussion between the radiation oncologist and the plastic surgeon and maybe your oncologist.  If you are not feeling comfortable with the information you are getting, you might consider a second opinion.