Reconstructive at same time as lumpectomy, then radiation?

I had breast conserving surgery along with a tissue repositioning/breast lift at the same time as the tumor removal, with a matching lift to the unaffected breast. I’d recommend this option for a few reasons -
- Doing it all at once was done in 3 1/2 hours for me, using a nerve block along with general anesthesia. I had very little pain after surgery because the nerve block lasted quite a while.
- The information about poor outcomes when doing radiation prior to reconstruction is focused on those that aren’t using existing breast tissue. When it’s just a rearrangement of your own tissue it actually might be better to do it before radiation as they can get better shaping when the breast is soft. After radiation the breast/skin may not be as flexible/soft making reshaping more difficult. See other comment on second surgery.
- I had partial breast radiation targeting the area where the DCIS was, marked with a tag viewable by the radiologist. I had hyperfractionalized volumetric arc radiation that layered radiation to the targeted area. They also used breath controlled radiation - which meant radiation was only given when I took a deep breath lifting the breast area up away from my heart and lung. I attached a picture from my radiologist of my radiation area.
- So I did have a second surgery, but I think this could have been avoided (which was frustrating). The plastic surgeon thought I was having whole breast radiation and created the affected breast larger to compensate for expected shrinkage. My surgery was in the transition time when shorter radiation options with partial breast were not in the protocols. The protocols were changed a few months later. However my radiologist presented the option to me for 5 days of radiation and showed the recent research that supported it (this plan was made after surgery after the final pathology report). I didn’t realize the implications - but the end result was my right breast was larger than my left. It was within their acceptable variance - but there was quite a bit of difference requiring extra padding needed in my bra to boost the left. They offered a simple second surgery to remove some of the extra tissue and after much self-debate I decided to do it. They ended up doing a bit more extensive surgery, removing an inch of internal scar that had formed, but it meant more tissue rearranging. I didn’t recover as well from this surgery, probably because no nerve block was used and higher anesthesia was needed, I was sick for days.
But this is what I wanted to tell you about doing reconstruction after radiation, the shape was better the first time around. This time the skin was a bit stiffer, and the underlying tissue where radiated was a bit firmer, causing this breast to sit higher than the other, not by much, but the first surgery was better. In retrospect, I’d still do the second surgery as I’m glad the scar tissue is gone, and I prefer the smaller breast. Originally I was a DD pre-BC and now both are a C+. But if the plastic surgeon knows what the radiation plan is beforehand, it’s much more likely that a second surgery would not be needed.

Thank you for replying!

I had an appointment with the radiation oncologist and was told if I do the repositioning, definitely whole breast radiation. I think because of the size of my tumor. I have invasive ductal carcinoma, stage 1b (i think), and the tumor is 3cm long by 2cm wide, but getting flat from the chemo. It’s 2 cm from the nipple, going down at a 7 o’clock position. So the surgeon will be cutting a few inches to get it out.
I guess I’m more worried that with removing such a large area of tissue, and then removing skin and moving tissue around, it will not be healed enough before the radiation will start. And then having the radiation on the whole breast, it’s just scary. Plus they will have to remove alot of tissue from the non cancer breast to match. I’m was also a DD before this all started, but have lost so much weight, both breasts have gotten super loose.
My surgery is scheduled as outpatient at a surgery center, expected to be 5 hours with an oncology and a plastic surgeon. Both surgeons are youngish, with 7-9 years experience. I’m in Houston, at MD Anderson, so I shouldn’t be worried about all this and just trust everything, but I still am.

Thank you so much for sharing your experience with me. It really helps to hear a real person, and not just the drs or online.

Consult with your oncologist and the dr. that will be in charge of radiation. Also - be aware that not ALL lumpectomy's need reconstruction. I had a huge tumor, my oncologist and surgeon both agreed on putting in a marker in the breast that had cancer, and doing several rounds of chemo first - if the chemo worked in shrinking the tumor, they would continue with that treatment until the tumor was much smaller and would be much easier to remove. That is what happened. After surgery, I had more chemo, and then radiation started. And here is the amazing part. The breast that had the cancer "bounced back" and resummed it's normal shape WITHOUT any dent or depression in it... just a small scar from where the tumor was removed. Also removed were 12 lymph nodes. The left breast (where the cancer was) remained "perky" and in great shape for almost 20 years, while the right breast was almost a cup larger and also began to sag as age and gravity will do. So I had once perfect c cup and one almost d cup boobs. I could have had a breast reduction in the right breast so both would "match" perfectly but I chose not to engage in further surgery. Last year, cancer returned to the left breast, and this time I opted for a double masectomy (I'm 75) and wanted no reconstruction because of the additional surgeries required, and the pain involved. This was the best move for me, although my friends tried to talk me out of it. Depending on the tumor you have, discuss with your surgeon and oncologist all options. Not all lumpectomies leave your breast looking really damaged. Good luck and good health, keep a positive attitude (not a goody-goody attitude) just remember this is NOT the worse thing that could ever happen to you, and you are you by how you live and act, not by how you look.

I'm adding to my comment: I'm also in Texas, and my surgeon was spectacular. She is so highly regarded. Arlington Memorial Hospital. They have state of the art breast cancer treatment & surgery center. I could have went to Houston, but am so lucky to have been recommended this surgeon from my surgeon and oncologists in NYC, where I am from. I would have flown back to NY for this second (& last) occurance of breast cancer but my insurance would not pay for it because I would be out of state. I am wishing you the best of everything and a very happy & healthy future.

I was 60. I had lumpectomy and reconstruction on both at the same time. “Out patient surgery “ ( 6 hrs surgery)I had no drains, but had to sleep on my back for quite some time. Radiation for 15 days and now on AI. Cancer was on left breast- so during radiation they will teach you how to hold your breath - if you don’t do it correctly machine shuts down. I didn’t have any problems- 2 yrs post- except fatigue
Concerning breasts- I love my results- plastic surgeon can do some fat graphing if needed.

I was 75 when I had IDC partial mastectomy and reconstruction combined surgery at Jax Mayo. 4 hours long and spent the night at the hotel on the grounds. Went from DD+ to smallC ( what I asked for) I have always had problems with a aesthetic but none this time; nopain-took only
one pill during entire recovery.
After radiation (5 days some kind of super duper) no breast changes.. I was and 50 months later remain glad I did it all at once.
Whatever you decide is best for you it will be.

thank you all for the replies!!

I am actually feeling a lot betting just knowing this is not an uncommon surgical practice. I do remember the surgeon saying they make the cancer beast a bit bigger to cover the shrinkage during radiation.

So for now, my tumor is shrinking, like getting flatter. So the goal is just small incision lumpectomy is a small about of tissue will be removed. Or, if the margins are not clear and more need to be removed, then the rearranged and lift will be okay too. I just finished chemo 5 yesterday and one more to go. Then only the targeted therapy for the next 6 rounds. The targeted infusions will be going on at the same time as the surgery and radiation, so that's something new to stress over lol.

Wishing you all the best of health during treatment and continued recovery!!

Lynn

I’m 66 had lumpectomy and reconstructive surgery at the same time. I am very glad I did. No more surgery, quick recovery and on the downside of my treatment. I recommend it.

@lynnmarie406 Ill be at MD Anderson on Aug 29, I think that’s after your scheduled surgery day though. I don’t live in Houston so I travel in and don’t hang around for long- but if we ever there together we should meet up! At my annual check I stay over 2 nights at the Rotary House hotel - very convenient, only for MDA patients, run by Marriott. It’s an easy indoor walk, or ride the indoor shuttle, to/from the MDA Mays Clinic. If you don’t want to sit in Houston traffic on your way home after surgery it might be an option you’d like. The walkway to it is near the Waterfall cafe, 2nd floor, Mays clinic.