Implant after Radiation
I had a lumpectomy followed by 21 radiation treatments one year ago which resulted in tight, thick skin and a hard, shrinking breast, muscle damage. I'm small breasted, age 57, 5' 7" and weigh 125 lbs and I had a tummy tuck 3 years ago. I work out regularly. My problem is that I wanted fat transfer to increase both breasts as well as heal my radiation damaged breast. I had surgery in August and my surgeon was able to place 180 cc's in each breast. About half took in the non radiated breast and about a 1/3 took in the radiated side. I'm noticeably smaller on one side and I don't think I have enough fat left to make up the difference. I already sacrificed my inner thighs, and they look terrible. Would I be able to get a small implant on the radiation damaged side? If so, what is the best type, form stable, silicon, textured, or smooth? I've been looking at the different types and sizes and I'm afraid my base(about12 or so) pushes me up into a larger implant size. The fat grafting did soften the breast and skin, but I still have some muscle tightness in my pectorals.
I agree with Dr. Whitfield on the benefits of 3D planning in these cases. Assessment of the skin excess you have on the unaffected side is key. The more you fat graft the unaffected breast the harder you are making it to match with the radiated breast. Some scar release, Rigotomies, SAFE lipo techniques with exploded Becker style cannulas, simultaneous separation and tumescence (SST) as well as expansion vibration lipofilling (EVL) techniques can optimize fat grafting as well as even out irregularities in the fat donor sites. A small implant may help, but complications like infection or capsular contracture may be a higher risk due to the radiation.
The problem with radiation injury to the skin and muscle is its permanent and can be progressive. Adding fat, which you have already done will help in softening the breast skin and soft tissue but, does not eliminate the radiation injury. Placing an implant, no matter what shape or form, most likely will result in capsular contracture and may accentuate the asymmetry. In cases where the skin is noticeably affected by radiation bringing healthy skin and muscle to the breast from a non irradiated areas gives the bestsellers long term results and an implant can be more safely added.
You may want to consider and Latissimus flap since you already had a tummy tuck.
I approach cases of this nature by using 3D imaging to better establish the differences in volume between the sides. On exam it is import to not the differences in the skin sided to side especially if the normal breast has more sag. These finding in conjunction with your exam are used to develop your indivisible plan. I would suggest to you that it gets more complicated with each revision unless the Plastic Surgeon is experienced in these types of cases. Matching a normal breast to a radiated breast is one of the most complicated cases.