Before and after bilateral mastectomies and immediate breast reconstruction using the DIEP flap in a 32 year old woman with aggressive breast cancer. She had completed neoadjuvant chemotherapy for a large left breast cancer that was involving skin, and she knew she required radiation therapy.
Flap surgery does not need to be delayed until after radiation. We know that radiation therapy usually shrinks tissue by 10-20% afterwards, and this process can take up to two years to be final. If we suspect that radiation will be required after flap surgery, we simply make the flap ten to twenty percent larger on the side that will have radiation to prepare for shrinkage after radiation.
She underwent a right skin sparing mastectomy and a left non-skin sparing mastectomy, with a large segment of skin removed. Although she was BRCA gene negative with no family history of breast cancer, she chose to have her nipples removed and to have a prophylactic oophorectomy (ovary and fallopian tube removal) and the same procedure.
She started radiation therapy six weeks after her DIEP flap surgery. follow up photos are shown immediately after radiation therapy. She will wait one to two years after radiation is complete to have nipple and areola reconstruction.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
