Ask Dr. Barber

Barber QA - Sept 15Q. I am 42 and had breast cancer 2 years ago.  I had a mastectomy, radiation therapy, and chemotherapy.  I am disease free which is wonderful, but I am reminded about my disease every time I look at my chest.  I was told that I cannot have breast reconstruction because I had radiation treatments.  Is there some alternative that could help me feel better about this?

A. Unfortunately, you have been given misinformation about whether you are a candidate for breast reconstruction.  You are a candidate for reconstruction, however you may be limited in the options of what kind of reconstruction you can have.  In general, there are two types of reconstruction, the first using implants to reconstruct the breast and the second option using your own body’s skin and fatty tissue from the abdomen or buttock area.  In patients who have previously had radiation treatments to the chest, there is a higher complication rate when using implants.  What your doctor may have been saying when you were told that you are not a candidate for breast reconstruction, is that you are not a perfect candidate for implant reconstruction.  The reason for this is that implants placed in an area that has been radiated have a higher risk of capsular contracture (hardness) of the reconstructed breast, higher risk of wound healing problems, and slightly more difficulty in matching the opposite side breast.  This does not mean that implant reconstruction cannot be performed, it only means that there are higher risks and that the results may not meet your expectations.
The second option that is more often used in women who have a history of radiation is to use skin and fatty tissue from the lower abdominal area and transfer it to the site of the mastectomy to reconstruct a breast mound.  This can only be done if there is an adequate amount of loose abdominal tissue that will come close to matching the size of the remaining breast.  This surgery is a bit more complicated but is commonly performed, and can lead to a very successful outcome, even in the face of previous radiation.  This surgery should be performed by an experienced breast reconstructive surgeon.  I would urge you to seek a consultation with a board certified plastic and reconstructive surgeon to find out more about your options.

Q. I have had breast implants for nearly 30 years and I do not want them anymore.  I am afraid what my breasts will look like after removal.  Do women ever remove their implants and what do they look like afterwards?

A. Do women ever remove their implants and leave them out, absolutely yes.  All older implants should periodically be checked by a plastic surgeon and sometimes need to be removed.  You should discuss your thoughts about your implants and what you would like to have done with a plastic surgeon. Your fear that the breasts might not look very good after implant removal is very common, however often women have put on weight over the years since the augmentation surgery, and as a result their breasts have naturally gotten a little larger.  As a result, when the implants are removed, there is more breast tissue than you might expect.  Because of this, there is rarely any deformity of the breasts, other than being smaller and possibly a little saggy, but most women are very tolerant of these changes.  One thing to consider regarding your 30 year old implants is the fact that there is a good chance they have leaked if they are silicone gel.  You may not be aware that they have leaked and the mammogram usually will not pick up a small leak.  It is not uncommon for implants older than 20 years to have some leaking going on.  So my advice to all women who have implants more than 20 years old is to visit a board certified plastic surgeon and discuss the best course of action to manage these older implants.

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