I take the opportunity to interview Dr. Minas Chrysopoulo of PRMA about the benefits of delayed DIEP flap breast reconstruction after radiation. It is always a pleasure to have him on the DiepCFoundation Channel to educate others about topics for those affected by breast cancer.
What are the Effects of Radiation?
Dr. C begins by explaining radiation often creates significant changes. Radiation is recommended to decrease the risk of breast cancer coming back locally in the chest area. He points out there is some data to suggest it can improve survival. For these two reasons alone, it is a very important part of breast cancer treatment to discuss with your health care team.
Techniques have improved in recent years in radiation, both the kind of radiation and how radiation radiation is administered for treating breast cancer. However, like many treatments for cancer, there are still side effects. Will the side effects be the same for each patient?
You can have two patients, identical diagnosis, identical treatment plan. One ends up doing really, really well with minimal radiation changes, whereas the other patient reacts much more significantly.
Dr. Minas Chrysopoulo
Some of these changes often include:
- Fibrosis or scarring of the radiated tissue
- Tightening of tissue
- Thickening of the radiated tissue
- Skin, fat, muscle near the chest wall on the radiated tissue can be affected.
- The lungs and heart can be affected depending on which side the radiation is on.
Even though there have been significant improvements in radiation, you cannot change the patient’s biology and an individual patient’s response to radiation.
Can DIEP flap be Performed if Radiation is Planned after Mastectomy?
Yes, it can, however, most plastic surgeons prefer to wait on the reconstruction until radiation and mastectomy have been completed. The main concern is the radiation will damage the reconstruction if you do it at the same time as the mastectomy. The time frame to perform DIEP flap after radiation and mastectomy by many plastic surgeons is after six months. Dr. C points out there are studies to suggest waiting up to twelve months is preferred. At PRMA, the group he practices with, they have performed it as soon as three months, and sometimes even less depending on the individual patient situation. This must be carefully evaluated, however.
Why Do Some Women Choose Delayed DIEP Flap?
There are a number of reasons. Here are some Dr. C discusses.
- Completing breast cancer treatments before any surgery
- Needing time to research the process of reconstruction
- Consideration of going flat
- Being certain they want reconstruction but not sure what type just yet
Women who have delayed reconstruction can have it performed at any time. However, there are those who have a very difficult time with the notion of waking up without breasts. These ladies are certain they want immediate reconstruction. Dr. C points out you have to understand and know your values and options both before making the decision.
My Personal Story and the Benefits of my Delayed DIEP Flap after Radiation
At the beginning of the video with his typical British humor and quick wit, Dr. C jokingly asks, “Did you say I’m one of your favorites?” Yes, I said it. It’s on tape, You’re right Dr. C. That rolled trippingly off the tongue because he was the microsurgeon who performed my DIEP flap.
I had radiation to my left breast as part of the treatment for my first diagnosis, experiencing fibrosis, scarring, and tightness. I did not have physical therapy after my two lumpectomies and radiation in 2002. The effects of radiation were something I dealt with on my own. When I went to the gym, I would stretch it out to improve my range of motion. For twelve years I lived like this until my DIEP flap breast reconstruction in late 2014.
Dr. C continues to explain for most delayed reconstruction cases women need a patch of skin showing on the breasts to reconstruct the overall skin envelope giving the breast the desired shape. In the case of immediate DIEP flap, it is very possible to have a lady look like she’s had a breast lift or a breast reduction especially in the setting of nipple sparring techniques. Thus, resulting in lots less scarring than a delayed DIEP. At this point I begin to squirm in my seat a bit while I listen to him say the results of delayed are not as good from a cosmetic standpoint and scarring is not as limited as in immediate DIEP flap breast reconstruction.
Then my body softens a bit as he explains the biggest benefit in delayed is being able to replace the damaged soft tissue with healthy tissue from another part of the body. Scar tissue can be released. Scar tissue can be removed replacing the entire area with healthy, soft, warm tissue from another part of the body. This new flap has a great blood supply with the very real possibility of improving the radiated side.
He stops for a moment. We both pause and he asks, “Does any of this resonate at all?” He knew what was on my mind. This was the story of my delayed DIEP flap breast reconstruction. I smiled, acknowledged his question, and began telling one of the best benefits I experience every night since having my delayed DIEP flap. I never laid on my left side after radiation in 2002. The scarring and fibrosis made it too uncomfortable. He smiled when I said I lay on my left side all the time now. My aesthetic results are beyond my expectations and scars are well-hidden below the nipple areola complex.
I encourage you when you are making your decision, no matter if you choose immediate or delayed reconstruction, to have the discussion and decision to be with a coordinated care team. This would include your oncologist, breast surgeon, plastic surgeon, and radiologist.