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HER2 Positive Breast cancer - Radiotherapy with or without recon. What are the risks?

Spleigh
Posted by

Hi,

My wife has Stage 3 Her2 positive breast cancer.  She is coming to the end of her chemotherapy and the oncologist advised us that we should consider delaying the breast reconstruction following the mastectomy by 12 months.  

She has the following treatments still to come:

  • Mastectomy and lymph nodes removed
  • 15 x Radiotherapy sessions
  • 12 months of Herceptin injections

Is there any serious risks to having the breast reconstruction at the same time as the Mastectomy?  Considering we still have the treatments above to come.

Thank you for any help or advice. 

Stephen

Kate C - Macmillan
Posted by

Hello

Thank your for your query.  I'm sorry to hear about your wife's diagnosis and upcoming treatment. 

There are no serious risks to having reconstruction at the same time as mastectomy, but a few facts that need considering before making a decision. Some people will opt to have a reconstruction at the same time as a mastectomy; others may choose to leave it. There is no right or wrong options, just whatever suits that person overall. 

If your wife were to opt for immediate reconstruction, she would need to wait until fully healed before having radiotherapy which may cause a delay.  Healing would be longer than if she were just having a mastectomy due to the associated swelling. However,  it's important to remember that after the chemotherapy and the surgery, the radiotherapy is a 'belt and braces' approach, so if radiotherapy were delayed, it isn't going to be detrimental by having to wait for surgery scars to heal. 

For those that have had a reconstruction before radiotherapy, there is a risk of the reconstructed breast becoming firmer and lumpy as a result of the radiotherapy. You can also get something called capsular contracture, especially if an implant has been used. This is where the internal scar tissue tightens and forms a 'capsule' around an implant or implanted tissue.   You can also get something called fat necrosis, which is where a fatty lump can form.  The risk of getting this is increased after radiotherapy as it irritates the blood supply around the breast. The risks of significant damage are really quite low, but nobody can predict who will recover well and who might have complications. There are no definites, but there's a chance it may cause some changes.  

If the reconstruction was delayed, then these risks would be minimised, but your wife would then have to wait at least 12 months after radiotherapy before having a reconstruction to allow the skin to recover.  Otherwise, you run the risk of the skin not healing properly after surgery due to the changes from the radiotherapy. 

It really is a difficult position to be in. Some people want to get all the treatment over and done with and get on with their lives and are happy to wait for reconstruction. On the other hand, some feel they would be psychologically affected after a mastectomy and can't bear the thought of not having an immediate reconstruction.  Some feel that getting all the surgery over in one go is a better option for them, rather than having to go through 2 major surgeries.  There is no right or wrong answer here, but your wife needs to be comfortable with the decision that she makes.  

She may find it useful to ask advice on the Breast cancer community board  so see what the ladies on there have done and how they felt with their decision. She could  also have a look at Breast Cancer Care - they have some great information on breast reconstruction. 

I hope that's been helpful. 

Best wishes, 

Kate 

Remember you can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or by email.  

Spleigh
Posted by

Hi Kate,

Thank you for providing such a detailed answer.  Really appreciate it.  It has made it much clearer for us.  Just one question, if my wife had mastectomy and reconstruction.  Typically how many weeks would it delay the radiotherapy by? 

Thanks Stephen

Kate C - Macmillan
Posted by

Hi

Difficult to say.  It would depend on how quickly your wife heals from the operation.  If she healed really quickly and didn't develop any post-op complications, then it wouldn't be by much at all. However. some hospitals may have certain guidelines as to when radiotherapy should start after reconstruction, so your wife's breast care nurse should be able to answer then more concisely for you. 

Best wishes, 

Kate 

Remember you can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or by email.