Reconstruction after treatment for stage IIIA?


Question from Dani: I had stage IIIA breast lobular breast cancer. I had a mastectomy and radiation. What would be the best option for reconstruction for me, and how long should I wait before reconstruction?
Answers - Maurice Nahabedian In general, for a IIIA breast cancer (which is a relatively large tumor) and after having had radiation, I would tend to wait about one year to make sure that there is a safe, disease-free interval. Then, generally, I would recommend performing some type of reconstruction utilizing one's own body tissues.

I generally do not recommend implant reconstruction after a mastectomy and radiation, primarily because there are some associated complications, such as infection, hardening of the breast, and distortion that can occur.
Marisa Weiss, M.D. What if this woman had a tissue expander placed at the time of original mastectomy and it is now expanded to the size of the new desired breast? If she had no problems with that expander in place for one year, is an implant an OK option for her?
Maurice Nahabedian Yes. Once the skin has been expanded and then radiation therapy started, the process is much better tolerated. Then I will usually go ahead and do an implant exchange as I would normally do. During that implant exchange, I would release some of the scar tissue that has formed and position the implant in an optimal location. Also, in patients who've had radiation to implants, I recommend an aggressive massaging protocol to help maintain the soft consistency of the reconstructed breast.
Marisa Weiss, M.D. Can you explain what you mean by this massage protocol?
Maurice Nahabedian I recommend they use some sort of a moisturizing lotion and massage the breast two to three times a day to retain the moisture and also to help control the amount of scar tissue that forms around the implant/expander.
Marisa Weiss, M.D. If a woman has a big cancer and her doctor recommends delayed reconstruction after her chemo and radiation is finished, do you think it's wise to place an expander at the time of initial mastectomy? The reason would be to keep that space between the skin and the chest wall, regardless of the type of final reconstruction (implant or tissue flap)?
Maurice Nahabedian In somebody with an advanced breast cancer who we know will be receiving adjuvant treatment, in those situations I assess whether the patient is interested in their own tissues or implant reconstruction. If they are interested in reconstruction using their own tissues, then I would more than likely recommend that they not do any expander at the time of the mastectomy.

However, if the patient is not a candidate for using her own tissue or is primarily interested in implant reconstruction, then I don't see any harm at placing an expander at the time of mastectomy to maintain an adequately stretched breast skin envelope. This will improve the future implant reconstruction.

On Wednesday, November 19, 2003, our Ask-the-Expert Online Conference was called Breast Reconstruction. Maurice Nahabedian, M.D. and Marisa Weiss, M.D. answered your questions about different techniques in breast reconstruction, the pros and cons of implants and body tissue transfers, when you might want to reconstruct, and many more issues related to rebuilding your breast/s after breast cancer surgery.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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