Bilateral Tissue Expander Breast Reconstruction With Previous Unilateral Breast Radiation Treatments

Posted on January 11, 2010 in Breast cancer, Breast reconstruction, Radiation treatment, Tissue expanders

In breast reconstruction, the ultimate goal is to recreate a breast that is as close as possible to the remaining breast. Perfect symmetry is naturally impossible. Even in situations where the reconstructed breast may be somewhat “similar” to the remaining breast in appearance in the immediate postoperative period, the two sides will invariably change or age differently over time, thereby increasing the differences.

Women who have undergone bilateral mastectomies inherently have better odds of obtaining symmetry in their breast reconstruction. Why? The reason is that they are often starting with similar deformities on each side, thereby allowing for the same reconstructive technique to be utilized for both breasts. This is true whether reconstruction is performed with the simple insertion of implants, usage of tissue expanders or with flaps such as a TRAM flap.

One notable caveat to this is if one side had been irradiated as an adjunct treatment of the breast cancer.  As I noted in an earlier post (Problems With Tissue Expansion Breast Reconstruction In Previously Irradiated Tissue), the ionizing effects of the radiation treatments damages the skin resulting in scarring, thickening, increased rigidity and less suppleness of the tissues which often also show visual signs of the damage. This translates into tissue that is more resistant to the stretching that is necessary with tissue expansion breast reconstruction as well as breasts that often feel quite rigid or hard.

The following case illustrates this exact scenario. The patient underwent a bilateral mastectomy with radiation subsequently performed on the left side. In the photos, you may be able to appreciate the slightly darker color and firmness of the skin.

a.) Bilateral mastectomies with left breast irradiation. Pre-op

b.) Bilateral mastectomies with left breast irradiation. Post-op insertion and inflation of tissue expanders

c). Pre-op

d.) Post-op insertion and inflation of tissue expanders

e.) Pre-op

f.) Post-op insertion and inflation of tissue expanders

She elected to undergo bilateral breast reconstruction using tissue expanders. Despite using identical tissue expanders, there is a significant difference in appearance between the two sides. Ironically, though the irradiated left side is inflated with more saline than the right, it actually appears less voluminous. That is an effect of the radiation damage.

If you would like to obtain additional information on breast reconstruction, breast implants or any other plastic surgery procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

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Problems With Tissue Expansion Breast Reconstruction In Previously Irradiated Tissue

Posted on August 31, 2009 in Breast cancer, Breast reconstruction, Radiation treatment, Tissue expanders

Radiation treatment following a mastectomy in the treatment of breast cancer is fairly common. Though refinements have been made in the radiation therapy that have significantly reduced both short and long term sequelae to the skin and underlying tissues, permanent consequences nevertheless exist which will affect the tissue expander breast reconstruction.

What does radiation do to the skin and soft tissues? The ionizing effects damage healthy cells causing scarring and thickening with increased rigidity of the tissues and less suppleness. The result is firmer feeling skin that is more rigid and more resistant to the stretching which is necessary with tissue expansion breast reconstruction. The small blood vessels in the field of treatment are also permanently damaged resulting in a reduction of blood supply to the tissues. Less oxygen and nutrients available to the tissues translates into an increased the risk of infection, greater susceptibility to trauma and prolonged healing times from surgery and injury. .

As a consequence of these changes, it is far more difficult to expand irradiated tissue in facilitating the breast reconstruction as compared to normal tissue. The increase in size obtained may be less than ideally desired and it can take much longer. Qualitatively, it often feels firm and appears darker than the surrounding skin. There is also an increased incidence of infections, formation of scar tissue around the expander, separation of recently closed incisions and even extrusion and exposure of the tissue expander through the skin.

Though tissue expander breast reconstruction can yield satisfactory results in tissue that has been previously irradiated, there are many attendant risks that need to be considered before selecting this option.

If you would like to obtain additional information on breast reconstruction or any other surgical procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

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