TRAM flap if implant unsuccessful?


Question from Debbie4: There was a statement on the side of this conference that states women that either will have or had radiation should not have an implant. My surgeon is recommending an implant, preferably silicone. If there is any problem with the implant than he felt that we could always do a TRAM. Does this sound like the right plan of action?
Answers - Carolyn Chang It depends upon how much we as plastic surgeons are willing to try riskier procedures as long as the patient is fully informed that there is a high possibility, or not a small possibility that the reconstruction would fail. The patient would have to be willing to have an autologous transfer in this case, in the high likelihood that the implants were to fail. So I don't think this approach is entirely unreasonable; however, you as the patient have to be very realistic about the chance that you're taking that the implant won't work. You can't be disappointed if it doesn't work. These are decisions that need to be made between you and your surgeon very frankly from both sides with full understanding.
Lillie Shockney, R.N., B.S., M.A.S. Women who are having mastectomy with chest wall radiation have a higher risk of an implant failing than a woman who had lumpectomy with radiation in the past and is now embarking on a mastectomy with reconstruction. It depends on the doses of radiation and the quality of skin remaining and the size of the breast. The basic thing you need to know about radiation is that it makes things more unreliable. It doesn't mean things are impossible, but it makes things much more unreliable.

Depending on your anatomy, the particulars of your cancer, and the amount of radiation that you had, you may or may not be a successful candidate for implant reconstruction. As a whole, it's much more preferable, if possible, to do autologous tissue. In medicine, it's rarely all or nothing, but I think the overwhelming problem with the lumpectomy patients is that they don't understand the effects of radiation on their skin, and if they come back with a recurrence and need to have a mastectomy they need to be aware that it makes an implant reconstruction more difficult.

Radiation affects the elasticity of your skin. It makes it difficult to expand the skin and even get the skin healed in certain patients. I have done many patients with Hodgkin's disease, and they have done just fine with mantel radiation. So it's not necessarily all types of radiation.

On Wednesday, April 20, 2005, our Ask-the-Expert Online Conference was called Reconstruction and Safe, Sexy CosmeticsCarolyn C. Chang, M.D., Anna-Dee Rinehart, S.C.S., and moderator Lillie Shockney, R.N., B.S., M.A.S. answered your questions about reconstructive surgery and safe, sexy cosmetics.

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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