What are my options for filling an indentation left after lumpectomy?

The most important component in the decision making is whether you have undergone or will undergo radiation therapy.  Radiation may affect your current breast implant and may further compromise your candidacy to undergo reconstruction with a prosthesis (tissue expander or implant).

Depending on the amount of radiation received, you may be a candidate for breast reconstruction using your own tissue.  Examples of these muscle flaps include the rectus muscle and latissimus muscle.

Recently, a lot of attention is being placed on the latissimus muscle as a suitable option for breast conservation reconstruction.  Refer to www.pubmed.org for references to these articles about the latissimus muscle.

Breast reconstruction after lumpectomy is becoming increasing common as breast conservation in the face of breast cancer becomes more sophisticated.  Many times lumpectomy defects can be very challenging to reconstruct.

The first issue involves whether you have had radiation.  Irradiated breasts are more common in people who have had lumpectomies and make reconstruction more complicated.

Typically radiation will require the usage of "autologous" tissue (meaning your own).  The benefit of this tissue is in this situation it would typically be taken from an area outside of the field of radiation and would not have radiation issues.  Many times patients who have had radiation will also require some amount of skin on the tissue that is transported.  The tissue that can be used includes lat. dorsi (back skin and muscle) or microsurgical breast reconstruction techniques including DIEP, SIEA or SGAP.  All these letters stand for different microsurgical flaps that are commonly used for breast reconstruction.

If you haven't had radiation local tissue rearrangement or custom implants might be used for reconstruction.  

In addition fat transfer can be very useful for filling in small defects with the qualification being sometimes the scarring can create calcifications that make breast cancer more complicated.

Typically injectables or alloderm alone would be an inappropriate choice for breast reconstruction, especially in a patient that had received radiation.

I hope this helps!

Steve Williams, MD

Depending on the degree of the deformity, there are several options including utilizing local tissue rearrangement with or without additional tissue which may include the use of a dermal implant such as Alloderm,  replacement or revision of your implant reconstruction,  and finally the use of autologous (your own body) tissue from another site such as your back or abdominal areas.  A consultation with a Plastic Surgeon is the best place to start.

Lumpectomy often results in the indentation that you describe. The problem is that every lumpectomy leaves you with a unique situation! It is thus very difficult to answer your question here as there are so many individual questions that need to be asked? How big is the indentation? Where on the breast is it located? Did you have radiation to the breast? Was the implant placed before the lumpectomy or as part of a reconstruction? All of these questions influence how a repair can be done. I agree completely with Dr. Wallach that a breast reconstruction can be performed with either local or remote tissue depending on the situation. Fillers such as Juvederm are not going to fix this problem, and even if the indentation was small enough that Juvederm could fix it, it would only be a temporary cure. Alloderm can often be used to cover the edge of an implant that you can feel but not to fill a hole per se... Go see a plastic surgeon, get an individualized exam, and have an individualized plan developed to fix your unique situation! Good luck!