DIEP Flap for Breast Pain after Radiation By Shareef Jandali M.D. on November 28, 2015

Radiation therapy to the breast is proven to decrease the risk of recurrence and improve overall survival after breast cancer. It is performed in cases of breast conservation after a lumpectomy or partial mastectomy. It is also indicated sometimes after a mastectomy when the tumor size is large or there are multiple positive lymph nodes. However, with the significant benefits of radiation therapy also come the unfortunate downsides.

Radiation causes irreversible changes to the tissues of the chest wall. Radiation is performed to kill any remaining cancer cells that may have been close to the surgical margin and decrease the risk of recurrence. While radiation has a positive effect on cancer cells, there is always some damage to the normal surrounding tissue and skin. Radiation causes injury to the microvasculature and fibrosis of the skin and underlying fat and muscle. This can cause permanent darkening of the skin, feelings of tightness in the breast area, and even limited range of motion of the shoulder. Patients can have chronic pain in the breast, especially if it was reconstructed with a tissue expander or an implant.

Radiation to a breast that was reconstructed with a tissue expander or implant can have permanent side effects. The implant almost always becomes hard and becomes elevated on the chest wall. It often becomes higher than the opposite non-radiated breast, causing significant asymmetry. A condition known as capsular contracture occurs to varying degrees with breast implants after radiation. The capsule is the scar that is around the implant, and this can become tight and hard and painful. Radiation doesn't actually affect the implant itself, only the tissues around it. Once a radiated breast implant is affected by capsular contracture, there is very little that can be performed to soften the breast and decrease pain from the hard implant. The best solution to capsular contracture is to remove the implant and reconstruct the breast using a patient's own tissue with a DIEP flap.

The benefit of replacing an implant with a patient's own tissue is that there is no longer any foreign body with capsular contracture. A patient's own tissue will be much softer and more natural appearing. Dr. Jandali's microsurgical team is one of only a few groups performing DIEP flap breast reconstruction for patients in Southern Connecticut. This procedure is a state of the art procedure using a patient's own abdominal tissue and transferring it to the chest to recreate a breast. This specialized procedure is muscle-sparing compared with a traditional free TRAM flap. Therefore, there is almost no chance of an abdominal hernia or bulge after surgery. The abdomen closes as if a tummy tuck was performed. The flap is connected to small blood vessels in the chest area with microsurgery. This is the ideal breast reconstruction for patients with radiated, hard, or painful breast implants.

If you are interested in breast reconstruction using your own abdominal tissue with a DIEP flap in Connecticut, come visit our plastic surgery office in Fairfield County, Connecticut. Call 203-374-0310 to set up a consultation with Board Certified plastic surgeon Dr. Shareef Jandali. We look forward to seeing you.