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Reconstuction after radiation

Core biopsy Jan 08 showed; (posterior) ductal carcinoma in situ and calcification, (anterior) DCIS, lobular carcinoma in situ and calcification. S/P 3 lumpecties and S/P radiation treatment and now taking tamoxifen. July 08 F/U mammogram showed fine linear calcificatons in the area of prior biospsy. This area biopsied last week, results: Focal atypical ductal hyperplasis, fibrosis and chronic inlfammation with foreign body giant cells, consistent with previous biopsy site, clusters of ductal cells raise suspicion for invasive carcinoma, however immunohistochemistry for myoepthelial markers shows no evidence of malignancy.  MD recommending mastectomy with reconstructive surgery. Not sure what to do now? Is reconstructive surgery an option after radiation treatments? What reconstructive procedure is recommended?

Thanks for any information you can provide.
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560109 tn?1220276267
MEDICAL PROFESSIONAL
There are 3 types of reconstruction available. The first is tissue expansion. This is usually eliminated by radiation . The second is Latissimus Dorsi flap[back flap] reconstruction which does utilize an implant but can be used in irradiated patient because fresh skin and muscle are brought in. The third type is autologous tissue, your own skin and fat moved into the mastectomy site. This is a pedicled flap known as a TRAM[tummy tuck flap], and the free flap technique where new blood vessels are connected to deliver tissue to the area. This can also be used in an irradiated area. The choice orf immediate reconstruction is actually preferred by most plastic surgeons, and as long as you do not receive further radiation, they yield great results. Your general surgeon probably has a plastic surgeon with whom he works all the time. Ask for his guidance. Good luck.
                  arch miller md facs
Helpful - 1
Avatar universal
There is another option for reconstruction:

DIEP Flap (Deep Inferior Epigastric Artery Perforator).  This is similar to the Free TRAM flap, but does not take any of the stomach muscle.  (Even though it's a longer surgery, overall recovery time is usually less. (Google "DIEP Flap" and you'll find many reliable resources to help you learn more about it). There are also other areas of the body that can be used for tissue transplant when you have a highly qualified and experienced surgeon doing the procedure.

It's fairly new in the U.S. so you won't find plastic surgeons in every city (even large ones) that do it.

I travelled out of my home state to get the procedure.

You'll probably need to go to a major medical center associated with a University.  I notice you live in Virginia.  I think you'll find that Georgetown and Hopkins both have surgeons highly qualified with this procedure.

Also, I had extensive radiation many years ago for treatment of Lymphoma.  I was told that implants are not a good option for me because of that. (My radiation was far greater than that which is commonly administered today for BC treatment).

Unless you have a particularly aggressive BC, you should be able to take some time to research your options before surgery.

Good luck.

Strike3
Helpful - 0
560109 tn?1220276267
MEDICAL PROFESSIONAL
Very good advice. There are only a few doing the procedure, and one needs to choose carefully. That is actually the free flap procedure To which I alluded in my response. There is actually a procedure called a GAP which takes tissue from the gluteus, or your bottom, and a procedure that takes the TRAM and uses only a small vessel dissected free from the muscle, thus sparing it. Thank you for helping her out,respectfully,

                                           arch s miller ms md facs
Helpful - 0

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