Posts Comments

You are here: Home / Archives for radiation therapy

Can I Have Natural Breast Reconstruction if I Had Radiation on my Right Side?

January 31, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: Can I get natural breast reconstruction if I have had radiation on my right side? I have had both breasts removed, but the first time the cancer was found I had a lumpectomy and radiation. The next time I had it removed.

A: Natural breast reconstruction with your own tissue is usually the best option for patients who have had radiation. Sometimes (but not always) it can be difficult to get the radiated side to match the non-radiated side as closely as desired because the radiated skin can be much tighter, but the chances of success are still usually much better using your own tissue than using implants.

We’d be happy to have our nurse Chris or PA Kim call to chat with you more about the specifics of your situation, if you wish.

Dr. Richard Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , ,

Can I Have Breast Reconstruction After A Lumpectomy? Will Insurance Cover My Reconstruction?

January 24, 2014 by

This week, Dr. Richard Kline and Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy 10 years ago. Can I have reconstruction to fix my breast? The scar is under my left arm and the lump was taken out of the left side of my breast.

A: Thank you for the question! Some women who have had lumpectomy and radiation to treat breast cancer  develop problems with the shape of their breast or problems with one side being smaller than the other. When this happens we recommend breast reconstruction. It is possible to remove the breast tissue and save the nipple and skin. Then at the same procedure  reconstruction with your own fatty tissue is performed. This has the advantage of removing the radiated scar and breast tissue and reduces the theoretical chance of breast cancer coming back in that breast. It should already be very low.

Dr. James Craigie

Q: I had breast cancer in 2002 in my left breast. A lumpectomy was performed and I only had radiation. I had a breast reduction on the right side to match the approxmate size of the left breast, but since then I have gained so much scar tissue around the left breast and it is now much smaller than the right breast. I am 69 years old, but still consider myself to be middle aged and attractive and this bothers me. Will insurance cover these procedures even though it has been over 11 years since the cancer and 10 years since the reduction? I have a Medicare PPO.

A: Insurance will cover almost any reconstruction-related procedures, if you have had the diagnosis of breast cancer.

There are several potential options available to you, depending on your goals. We would be happy to have our nurse Chris or PA Kim call to discuss your situation further,  if you wish.

Dr. Richard Kline

Thanks for your inquiry!

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , , ,

Should I Get Permanent Sutures to Help My Implant After Lumpectomy?

January 17, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a lumpectomy followed by chemo and radiation treatment. The tumor was on the inner edge of my left breast — basically skin and bone. My plastic surgeon (whom I respect and appreciate) used an implant and Neulasta. He formed a sling and sewed in to my sternum and ribs. I’ve had this procedure done twice. Each time the sutures were absorbed, the skin lifted and resulted in symmastia. I am wondering if non-dissolvable stitches along with sewing the neulasta to the area behind my breast which wasn’t super blasted  — forming a sort of “sail” would be an option. I would be interested in what you think and what solution you might have.

Thank you for your time!

A: We primarily do flap, not implant reconstruction, but I can still offer some insight.

Permanent sutures could possibly help, but if there is long-term significant force on them (which it sounds like there may be), they can work their way through soft tissue and still come loose (just like an orthodontist can move teeth through bone over long time periods). Nonetheless, it’s probably worth a try, especially if you liked the way your breast looked before the sutures dissolved.

There are also some potential options using your own tissue. Unfortunately, replacing the defect with free fat grafts, while technically straightforward, is a little controversial, as there is some concern that this could increase the risk of local recurrence (but this is far from definitively established). There are centers (one in Boston comes to mind) who are doing this as part of a controlled study. Also, depending on the size of the defect and the location of your scars, reconstruction with a small microsurgical flap might be a reasonable (although significantly more complicated) option.

It sounds like you have a good relationship with your surgeon, which is great. Please continue to share your thoughts with him, and I’m confident things will work out for you one way or another.

Dr. Richard Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , , ,

How Long Will Radiation Postpone My DIEP Reconstruction?

January 10, 2014 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: If I am having Mx and immediate DIEP reconstruction surgery that it is determined that radiation will be necessary, is the the DIEP reconstruction continued as planned, or is it postponed until after radiation? If postponed, are tissue expanders temporarily placed until six months later when flap surgery can be performed?

A: We have never, fortunately (as far as I can recall) encountered findings in surgery that caused us to suddenly think that radiation would be needed when we didn’t suspect it previously. The two things that COULD be found intra-operatively and would lead to that would be positive lymph nodes or a very large tumor. The mammogram and MRI are pretty good at seeing these kinds of things preoperatively. Additionally, if there is any suspicion of positive nodes, we routinely have the sentinel node biopsy done as a separate procedure before the mastectomy.

When we DO know that the patient will need radiation, we sometimes offer them placement of a temporary tissue expander if they do not want to go several months without having a breast mound. This has several disadvantages, including 1) doing unnecessary damage to the chest wall and pectoralis muscle, 2) taking up some of the eventual flap’s volume to fill the divet in the ribs left by the tissue expander, and 3) potentially interfering with the delivery of radiation. Some surgeons think the scar pattern can be favorably altered by and expander in this scenario by keeping the skin stretched, but I’ve never been very convinced by this argument, at least not when the expander is ultimately going to be removed and replaced with a flap.

If we did, for whatever reason, unexpectedly determine in surgery that the patient needed radiation, I would probably just do nothing (no tissue expander) and come back after radiation and do the flap(s).

Dr. Richard Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , ,

Does Radiation Affect My Options For Breast Reconstruction?

June 3, 2011 by
Dr. James Craigie

Dr. James Craigie

The question below is answered by Dr. James Craigie of The Center for Natural Breast Reconstruction.

I am not sure if I will need radiation after my mastectomy. What factors should I consider before going ahead with breast reconstruction?

Radiation therapy is part of the treatment for breast cancer for some but not all patients. To determine if it is necessary for any individual, the details of the cancer or the final path results must be known. The most common situation for radiation after mastectomy is based on the size of the cancer and the number of positive lymph nodes.

When a patient would benefit from radiation the treatment may affect the options for breast reconstruction as well as the timing of the reconstruction. There are several advantages to starting the breast reconstruction at the time of the mastectomy. These include: the breast surgeon can save more of the breast skin or even the nipple and this can set the stage for the best possible result, and avoiding an extra step and an extra recovery period.

If radiation will definitely be needed after mastectomy then I do not recommend immediate natural breast reconstruction because the radiation can possibly damage the new breast. In this situation the reconstruction would start approximately 6 months following radiation. These decisions are best made following the advice of your oncologist, breast surgeon, and plastic surgeon all working together. For this reason I am a strong advocate of the multi-specialty breast conference where each patient can be presented to all the specialists at once so they can share their opinions right away. Cooperation between experts can ensure better results and more options for each patient.

It is important to remember that if you need radiation for the treatment of breast cancer it does not mean you cannot have a very good result with natural breast reconstruction. It may however determine the order and timing of when the breast reconstruction should begin.

—James E. Craigie, MD

 

Filed Under: Ask the Doctor Tagged With: , , , , , , , ,