I am having a lumpectomy (left breast) this Thursday and most likely radiation for High Grade DCIS. I had the option of mastectomy, but I'm not ready to do that, so I opted for lumpectomy. I have small breasts (barely an A). I am 40 yrs. old and thin with a petite to medium body type. Do you think implants will ever be an option for me down the road? I don't care for the dieflap procedures. Of course, my cancer is my main concern right now. But just wanted to know what my long term options are for reconstruction. I know that lumpectomies don't normally reconstruct but my breasts are so small. I don't see how there will be much left on the left side after surgery. Please advise. thank you.

I have similar concerns. I underwent a lumpectomy, radiation and chemo 13 1/2 yrs ago. The radiated breast is now about a cup size smaller than the other. I am wondering if I can have implants after radiation.

Radiation is 'The gift that keeps on giving'. Meaning that radiated skin, not only has poor blood circulation through it, but it continues to shrink forever. Consequently, a doctor will not make an incision through skin that has been radiated since the risk of necrosis is too high, plus the skin will endlessly tighten itself over an implant until the skin splits. (takes a decade or two usually) That said, if the doctor can bring in a fresh blood source, as is done with a flap transfer, then you'll be fine.

That sucks. A flap would be for reconstruction only right?

That does stink. However, my plan is to give my breast a year and see if I am comfortable with the way it looks. If I don't like it, I will see the best plastic surgeon I can find who specializes in breast reconstruction and get an opinion about my options. I don't think I would do "flap". It seems like a lot to go through. I do feel that every case is different and only a doctor can access the situation correctly. That's just my two cents.

Let me know what you find out. I too plan on checking it out but just havent gotten around to it as afraid it will be bad news I guess

I would get a few opinions when checking things out. I have a neighber who had radiation after her lumpectomy and then had implants put in to bring her to a size b. So it sounds like it can be done but I am sure it is a case by case basis.

hi im new to the site, i had bc dx in '06 then again had new primary in '06 so had mast in '07 had rads so had to wait for reconstruction. its been two years, i am now recovering from a ld flap, slim build, had good breast augmented submuscular. Both breasts look good, good size about a 'c' cup this is UK so not sure if thats the same for you, but so far so good!

jacqui x

I too have small breasts. I had a lumpectomy early this year but none of the margins are clear. Because the cosmetic result would be undesireable, I am having a reconstruction. I also have high grade DCIS but no radiation is planned. Were it so, I have been reading that there are many ways to get around the bad effects that radiation has on the skin and breast tissue. One person hit it on the head> TAG, DIEP or other flap; however, if you are very thin like me there is not much tissue there. I am having a tissue expander installed in my left chest at the time of mastectomy. I dont see why they cant put a tissue expander in your abdomen or inner thigh to provide a blood source to the donor tissue at the donor site. There is a good book on reconstruction available the author is Kathy Steligo.

hi everyone - i am not in fact a breast cancer patient but i have come to learn a ton about reconstruction options from working in a plastic and reconstructive surgery office where 90% of our patient's are breast cancer patients. one of the hardest things about working where i do is that i can't tell patients what to do nor can i really tell them what i would do if i were in there shoes...

to be completely honest, if i learned that i tested gene positive for breast cancer or even got a breast cancer diagnoses, i would 100% opt for a double mastectomy. i've come to this conclusion because too many of our patients opted for only a lumpectomy and not only ended up needing reconstruction because of a bad cosmetic result, but also because they wind up with cancer again or in the other breast (also why if i only had a diagnosis of cancer in one breast why i would get both removed).

the surgeon's in my practice tend to hold off on reconstruction for people using flaps (their own tissue) if the patient is undergoing radiation just so the flap tissue doesn't get radiated. if there is time and a patient is not a candidate for the flap, they will try to use the tissue expanders and get the skin stretched before radiation begins, and then place the permanent implant once the radiation is over so they no longer need to stretch the skin once radiation is complete. the most common areas to take skin from for a flap procedure is either the stomach (diep flap) or from above the buttock (sgap). our doctors also use a flap from the inner thigh if the patient is a candidate. regardless of where this tissue is taken from, a patient never gets an expander to create more tissue for a flap (they don't get an expander placed in their thigh, stomach, etc...). if a patient would need their skin to be stretched in order for it to be used for a flap, our surgeons would only give them the option for the tissue expander reconstruction.

hope this is helpful - please feel free to ask me any questions!!!

I don't understand how you can be given option of a mastectomy or not? Usually the surgeon stops when they reach clear margins. Not having a mastectomy if the surgeon reccomends it is just so risky. Mastectomy is confronting but you are only 40, you have a lot of living left to do. Breast cancer is VERY aggressive in pre-menopausal women, especially if the cancer is ER positive.

My surgeon took 3 surgeries before I got clear margins. I had a lumpectomy, a partial mastectomy, and finally the mastectomy. At that stage I told them to remove the other breast too because I didn't want to run the risk of having a recurrance in the other side.

Like Christina Applegate I had a bilateral mastectomy and a delayed reconstruction with tissue expanders (too skinny for flaps, and delayed it till after I finished chemo). But if circumstances permit you can have a reconstruction when you have the mastectomy. The reconstructions look fab, and the scarring is much less than what you would expect.

I'm with unevennomore.... if I had found out about the BC earlier, or that I was gene positive I would've had a preventive mastectomy. No matter how horrible that might be, it is still better than chemo, early menopause and facing an uncertain future.

Hello,

Not to be a "killjoy" here but implant reconstructions do not usually do so well after radiation therapy. The rate of contracture is high. In small breasted ladies I frequently recommend mastectomy followed by implant to make the reconstruction less chancy.

in the office where i work, our patients who have opted for immediate reconstruction using a diep or sgap (meaning they have their mastectomy and immediately have their reconstruction using their own tissue at the same surgery) but wind up having positive margins/lymph nodes always wake up with an expander in instead of having the flap. they are told there is a chance of this before the surgery. this is done because most likely with positive lymph nodes radiation will be used for cancer treatment. the doctors don't do flaps at this point because they don't want their new tissue to be damaged by radiation. by doing the tissue expander (and either expanding as much as they can before radiation and/or starting after radiation and just expanding very slowly) they don't have to worry about damaging a potential good flap. this is also because if the expander reconstruction fails due to radiated skin, a flap IS STILL an option for the patients. we have lots and lots of patients who get expanded after radiation it's just a much much longer process. i've seen some have problems with wounds but i also see a lot who wind up being completely fine.