“Do I still need to have mammograms after my mastectomy and breast reconstruction?”
I’m asked this question quite often.
The truth is there’s a lot of ongoing debate about this.
Some doctors feel that since there is no “natural” breast tissue left, there is no need to continue monitoring patients. I disagree with this strongly.
Breast cancer can come back after mastectomy - there’s a 6.7% chance in fact. Breast reconstruction does not increase or decrease the risk of recurrence at all - the recurrence rate is the same whether women have reconstruction or not.
Since the risk of breast cancer recurrence is a real one, surely we need to continue some sort of monitoring?
Self breast exam is a no-brainer. It’s relatively easy to perform and it’s dirt-cheap (free). The issue of mammograms is less clear-cut.
The appearance of the mammogram changes completely after breast reconstruction. Even if the breast looks very natural and similar to the way it did before the mastectomy on the outside, the inside of the breast is completely different.
Let’s take the following example: a woman who undergoes a skin-sparing mastectomy and tissue (flap) reconstruction like a DIEP flap may look like she has natural breasts that have merely been “lifted”. In reality her breast tissue has been completely replaced by tummy fat. Fat and breast tissue look completely different on mammograms so the post-reconstruction mammograms cannot be compared to any taken before the mastectomy. You’re essentially starting from scratch as far as the mammograms go.
Some surgeons feel that patients should have 1 mammogram after the reconstruction has been completed just to get a new “baseline”. If the regular self breast exams reveal anything new of concern then the mammogram can be repeated. At least now the new mammogram can be compared to the baseline mammogram.
Other breast surgeons take it a step further and recommend a baseline MRI once the reconstruction is completed instead of a mammogram. MRIs are much more sensitive and the information they provide is also more specific. Again, if self breast exam reveals a new area of concern in the future the MRI can be repeated to see if anything has changed.
Yet one more viewpoint is that any new breast lumps that appear in the future are going to require a biopsy anyway so what is the point of getting a “baseline” MRI or mammogram at all?
I understand this point of view but don’t agree with it. Tissue (flap) breast reconstructions can occasionally develop something called “fat necrosis”. These are areas of fat in the new breast that become hard and create “lumps”. While a biopsy may indeed be planned anyway, there is a lot to be said for the physician and patient knowing this “lump” has been there all along (on the MRI) and the chance of this representing a new cancer is extremely low. The additional peace of mind and information a baseline MRI provides in this situation alone warrants it in my opinion.
What do I recommend? At least a baseline mammogram and self breast exams. If it was my wife she’d get a baseline MRI 6 months after the breast reconstruction and continue monitoring herself with monthly self breast exams.
Traditional medical opinion states that women with metastatic breast cancer are not candidates for breast reconstruction. Once metastases are diagnosed (stage 4 breast cancer), attention turns solely to aggressive medical treatment to prolong life. Breast reconstruction is no longer discussed as an option.
At least that was the consensus up until fairly recently.
Opinions have started to change over the last few years.
While we are still losing the battle with stage 4 breast cancer and most women will die from their disease, who are we to decide that these women should not be made “whole”? Why should any women interested in breast reconstruction die breastless?
As long as patients interested in reconstruction are medically stable and passed “fit for surgery”, the psycho-social and quality of life benefits that breast reconstruction can provide should not be ignored. While the priority must always remain “life over breast”, breast reconstruction should be discussed with patients regardless of the stage of the disease.
Radiation therapy is often recommended as part of breast cancer treatment. Patients undergoing lumpectomy receive radiation routinely once they’ve healed from surgery. Some mastectomy patients also need radiation after surgery depending on the characteristics of the tumor.
I think it is fair to say that most reconstructive breast surgeons, myself included, are not particularly fond of radiation because of the way it impacts the patient’s tissues (and breast reconstruction in general.) Nonetheless, it is important to remember that “life comes before breast” and in certain situations there is a definite benefit for the patient in having radiation therapy.
So what’s the problem with radiation therapy (from a plastic surgeon’s perspective)? For starters it can cause toughening (fibrosis) and shrinking (contracture) of the patient’s tissue which makes the tissue lose its elasticity and become more tough and rigid. Skin color changes are common, red at first turning more brown over time. Radiation can also cause burn injuries as well as damage to underlying organs such as the lungs and heart. Anyone who is facing radiation therapy must discuss all the potential risks with their their radiation oncologist beforehand.
Women undergoing lumpectomy are often told that most of their breast will be preserved and that radiation is given “as insurance” to decrease the risk of cancer recurrence. What many women don’t appreciate is that the breast can end up looking vastly different once the treatment is done because of radiation changes, even though they underwent “breast conservation”. Many women end up going to see a plastic surgeon anyway to fix this unforeseen problem, which ironically can include the same reconstructive procedures as for mastectomy.
Radiation after a tissue reconstruction (eg tram flap, diep flap) can cause the reconstructed breast to shrink and harden. Unfortunately, this is a fairly common scenario. Less frequently (with heavy radiation doses), new wounds can develop in the reconstructed breast which need wound care. Patients facing radiation after flap breast reconstruction should know that there is a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.
Tissue expander / implant reconstructions fair even worse with radiation. The complication rates in this setting are much higher than with tissue reconstructions, including complete failure of the reconstruction altogether (and removal of the implant). Some surgeons routinely offer implant reconstructions to patients that are either facing or have already had radiation therapy. There are even articles published in the plastic surgery literature supporting it. I have to respectfully disagree (strongly). In my experience mixing implants with radiation typically ends badly. I will only do this in the very rare instance that there is absolutely no other option.
So what’s the take-home message?
1) “Breast conservation” can fall short of the patient’s cosmetic expectations.
2) breast implants and radiation do not mix well.
3) If you’re facing radiation after mastectomy think twice about insisting on immediate reconstruction. You may be lucky and things may work out just fine. However, there’s also a good chance you’ll be signing up for more surgery than you bargained for.
San Antonio, TX (PRWEB) February 23, 2009 — Plastic, Reconstructive & Microsurgical Associates (PRMA) of South Texas, a leading breast reconstruction surgery practice in San Antonio, is now offering women the Transverse Upper Gracilis (TUG) flap procedure to restore their breasts after mastectomy. PRMA plastic surgeons specialize in breast reconstruction after breast cancer, with particular expertise in advanced microsurgical techniques using the patient’s own living tissue.
“Increasingly, women facing mastectomy prefer new breasts sculpted from their own skin and fat, thereby avoiding the problems that often occur with implants,” says Dr Chrysopoulo. Breasts shaped from living tissue have a natural look and feel that can’t be achieved using implants or temporary prostheses. “While most patients prefer the Deep Inferior Epigastric Perforator (DIEP) flap technique which uses a woman’s lower abdominal tissue, it is a technique that may not be an option for those who have had previous tummy tucks, who don’t have adequate abdominal fat, or who prefer not to scar their abdomens. TUG flap surgery is a viable option for these women; a way to restore their natural breasts with excellent results.”
Both the TUG and DIEP flap procedures are complex, technically demanding microsurgical procedures requiring special skill and experience. During the TUG procedure, surgeons transplant a flap of skin, tissue and muscle from a woman’s upper thigh to her chest. The process has distinct advantages compared to other types of natural tissue breast reconstruction: thigh tissue has superior contour, shape and projection; loss of the muscle does not inhibit an individual’s mobility or function; scarring is not easily visible, and the procedure produces a cosmetic thigh lift as well as a new breast.
“TUG flap surgery allows a woman to come out of the operating room the same way she went in,” says Chrysopoulo. “With nice-sized natural breasts in place.” The TUG flap is an excellent post-mastectomy option for women who have mastectomy to either treat or prevent breast cancer.
Candidates for the TUG are women who:
" have small to medium-sized breasts.
" want to avoid an abdominal scar.
" lack sufficient abdominal tissue for DIEP breast reconstruction.
" have had a previous tummy tuck or other abdominal surgery.
PRMA board-certified surgeons routinely offer both reconstructive and cosmetic breast procedures, and perform more than 400 microsurgical breast reconstructions annually for patients from Texas and across the U.S. PRMA surgeons are in-network for most U.S. insurance plans. Visit www.prma-Enhance.com or contact 800-692-5565 to schedule a consultation or for more information about the TUG flap or any other reconstructive breast procedure.
It was an absolute pleasure to talk to DeLeon and Travis on “DeLeon Dialogue” last night.
Breast cancer survivor DeLeon and cervical cancer survivor Travis talk frankly with their guests about quality of life as cancer survivors in remission. They discuss side effects, spirituality, mastectomy, sexuality, health and wellness, self-esteem, food, exercise, relationships, and everything else in between.
Last night the one-hour show was about “breast reconstruction after mastectomy”. We managed to cover a lot of ground - we talked about the various cutting edge breast reconstruction options currently available, breast implants, the impact of radiation therapy on reconstruction, recovery from surgery, and insurance coverage for reconstruction. Please click on the link below to listen to the show (may take a little while to load):
Having breast cancer in one breast increases a woman’s chances of getting breast cancer in the second breast at some point in her lifetime. A study in the March issue of Cancer addresses a question which women facing mastectomy for breast cancer have been asking doctors for years…. should I have my other (”good”) breast removed as well to decrease my risk of future breast cancer in the other breast? Here’s the study abstract….
“Predictors of contralateral breast cancer in patients with unilateral breast cancer undergoing contralateral prophylactic mastectomy.”
Min Yi, Funda Meric-Bernstam, Lavinia P. Middleton, et al. CANCER Print Issue Date: March 1, 2009
BACKGROUND:
Although contralateral prophylactic mastectomy (CPM) reduced the risk of contralateral breast cancer in unilateral breast cancer patients, it was difficult to predict which patients were most likely to benefit from the procedure. The objective of this study was to identify the clinicopathologic factors that predict contralateral breast cancer and thereby inform decisions regarding performing CPM in unilateral breast cancer patients.
METHODS:
A total of 542 unilateral breast cancer patients who underwent CPM at The University of Texas M. D. Anderson Cancer Center from January 2000 to April 2007 were included in the current study. A logistic regression analysis was used to identify clinicopathologic factors that predict contralateral breast cancer.
RESULTS:
Of the 542 patients included in this study, 25 (5%) had an occult malignancy in the contralateral breast. Eighty-two patients (15%) had moderate-risk to high-risk histologic findings identified at final pathologic evaluation of the contralateral breast. Multivariate analysis revealed that 3 independent factors predicted malignancy in the contralateral breast: an ipsilateral invasive lobular histology, an ipsilateral multicentric tumor, and a 5-year Gail risk 1.67%. Multivariate analysis also revealed that an age 50 years at the time of the initial cancer diagnosis and an additional ipsilateral moderate-risk to high-risk pathology were independent predictors of moderate-risk to high-risk histologic findings in the contralateral breast.
CONCLUSIONS:
The findings indicated that CPM may be a rational choice for breast cancer patients who have a 5-year Gail risk 1.67%, an additional ipsilateral moderate-risk to high-risk pathology, an ipsilateral multicentric tumor, or an ipsilateral tumor of invasive lobular histology.
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So what does all this mean?
This study basically concludes that prophylactic (ie preventive) mastectomy should be recommended to breast cancer patients in the following situations:
1) the breast cancer is particularly aggressive or invasive
2) the biopsy pathology report shows high risk histology (such as “invasive lobular” disease)
3) there are multiple tumors in the same breast
4) a 5-year Gail risk of at least 1.67 - The “Gail risk” assesses a woman’s risk of developing breast cancer by looking at a number of health factors including her medical history, race, age and more.
5) age 50 or older at the time of the first breast cancer diagnosis.
This study is helpful. I’d like to expand a little on the effect age has on risk of future disease. Many doctors (including myself) recommend prophylactic mastectomy to young women, particularly if they have a family history of breast cancer, as these women have the highest overall risk of getting another cancer in their lifetime. Previous studies have shown that breast cancer patients have close to a 1% risk of another cancer per year. This risk is cumulative, in other words, it adds up: 1 % risk after 1 year, 10% risk after 10 years, 30% after 30 years, and so on. This cumulative risk is important to remember.
While I applaud this study and think it’s results are very useful, I also think it is imperative that doctors remember the primary indication for prophylactic mastectomy: the patient’s wishes. Breast cancer is such a devastating disease both physically and emotionally. We can educate our patients all we want about study results but we must not forget the erosive nature of anxiety over the possibility of a second breast cancer in the future. If one of my patients wants a prophylactic mastectomy even after discussing the studies, that’s good enough for me.
The ideal breast reconstruction technique is one which allows reconstruction of a “natural”, warm, soft breast with the least impact on the patient’s body. While breast reconstruction with stem cells may not be too far off, until it becomes a reality we are limited to using the patient’s own tissue to achieve these goals. As discussed in the previous posts in this breast reconstruction series, until fairly recently the only “tissue reconstruction” options involved sacrificing muscle. This made recovery from the surgery difficult and painful, not to mention the risk of long-term muscle function loss and weakness.
Perforator flap techniques use skin and fat from various parts of the body. All muscles are preserved. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. The downside to these procedures is that they are technically much more demanding than other breast reconstruction techniques and require microsurgical expertise. For this reason they are not offered by many plastic surgeons and patients must be prepared to travel when choosing these procedures.
The DIEP flap is the latest evolution of the TRAM flap (discussed in Part II) and represents today’s gold standard in breast reconstruction. The DIEP flap procedure is similar to the TRAM flap but only requires the removal of skin and fat. NO MUSCLE is sacrificed. The blood vessels required to keep the tissue alive lay just beneath the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to dissect the vessels and microsurgery is required to reattach the blood vessels to the chest area.
Even though an incision is made in the abdominal muscle NO abdominal muscle is removed or transferred to the breast in the DIEP flap procedure. As a result, patients do not have to sacrifice their abdominal strength and they experience less pain and a much quicker recovery. The risk of abdominal bulging and hernia is also very small.
The DIEP flap was first described in the early 1990’s but has remained much less popular than the TRAM flap among plastic surgeons, presumably because of the increased complexity and difficulty of the procedure compared to the TRAM.
So the advantages of the DIEP flap are multiple: it uses living tissue to recreate a breast that often looks and feels like a normal breast; abdominal strength is not affected; the risk of bulging or hernias is significantly reduced; and, like the TRAM flap, the patient benefits from a simultaneous “tummy-tuck”.
The DIEP flap is a very technically demanding operation but the benefits are tremendous for the patient, especially when performed at the same time as a skin-sparing mastectomy.
The SIEA flap procedure is very similar to the DIEP flap procedure. The main difference between the SIEA and DIEP is the artery used for blood flow supply to the reconstructed breast. The SIEA arteries are generally found in the fatty tissue just below skin.
As in the DIEP the SIEA flap reconstruction does not sacrifice the abdominal muscle and only uses the patient’s skin and fat to reconstruct the breast. While the SIEA flap procedure is similar to the DIEP it is used less frequently since less than 20% of patients have the anatomy required to allow this procedure.
Women who do not have an adequate amount of abdominal tissue for reconstruction may be eligible for the GAP flap. This procedure uses excess skin and fat from the gluteal or buttock region. Fat and skin from either the upper or lower buttock region can be used and microsurgically transplanted to the chest.
Once again, no muscle is sacrificed. Incisions can generally be hidden by most underwear. If a patient requires a bilateral reconstruction with GAP flaps most surgeons prefer to only perform one side at a time. It is important to discuss this possibility with your surgeon.
Advantages of the GAP flap include: a scar that is generally hidden with underwear or swimsuits, and no loss of muscle function or strength.
Other Breast Reconstruction Options:
TUG (Transverse Upper Gracilis) Flap
Like the GAP flap, the TUG flap is an option in cases where there is not enough lower abdominal tissue to reconstruct the breast(s). The TUG procedure uses the upper part of the inner thigh; skin, fat and a small amount of muscle are disconnected and transferred to the chest to create the new breast. The patient benefits from a simultaneous inner thigh lift. Once again, this procedure is not widely available due to its complexity and need for microsurgical expertise.
It is important to realize that whichever method of reconstruction is used, the vast majority of women will require 2 or even 3 procedures for the optimal cosmetic result. Each procedure is typically separated by several weeks. The entire reconstructive process, regardless of the method of reconstruction, can therefore take several months to complete. However, breast reconstruction does NOT typically complicate or delay cancer treatment such as chemotherapy.
With all this in mind and also remembering the superior cosmetic results associated with immediate breast reconstruction (reconstruction performed at the same time as mastectomy), it is recommended that women discuss their reconstructive options with a plastic surgeon specializing in breast reconstruction before undergoing mastectomy whenever possible.
Women interested in breast reconstruction after mastectomy have several reconstruction options to choose from. In Part I of this series we discussed tissue expanders, breast implants and Alloderm.
Though implant reconstruction remains the most common method of breast reconstruction in the US, many women are now steering away from this option, opting instead to use their own tissue for more “natural” results. Muscle flaps have, until fairly recently, been the only choice available for these tissue reconstructions. The most commonly offered muscle flaps are the latissimus and TRAM flap procedures.
The latissimus procedure uses muscle from the back of the shoulder blade which is brought around to the breast mound to help create a new breast. During the procedure a section of skin, fat and muscle is detached from the back and brought to the breast area.
Many patients also need a tissue expander placed under the muscle flap in order to obtain a satisfactory result. The expander is replaced by a permanent implant at a second procedure down the line.
Patients will have a scar on their back shoulder region that can sometimes be seen through a tank top, swimsuit or sundress. The upper back can be numb or sore for a few following this procedure until the nerves grow back and the incisions are completely healed.
Women who are very active in sports should know that this procedure can reduce ability to participate in activities like golf, climbing, swimming, or tennis.
The TRAM flap was the first procedure to describe use of one of the rectus abdominis muscles (sit-up muscles) for breast reconstruction. This procedure begins with an incision from hip to hip rather like a “tummy-tuck”.
A “flap” of skin, fat and one of the patient’s abdominal muscles is typically tunneled under the skin to the chest to create a new breast. This is known as a pedicled TRAM flap. Recovery from the TRAM flap procedure can be difficult and painful and there is a risk of abdominal bulging (or “pooching”) and even hernia. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%) which most active patients will notice.
In cases where both breasts are being reconstructed, both abdominal muscles are sacrificed and transferred to the chest (one for each breast). The loss of abdominal strength in these situations is far greater and very significant.
Over the years and with the introduction of microsurgery, the procedure has evolved several times with each modification preserving more and more abdominal muscle. This has made postoperative recovery a little easier and has decreased the potential for abdominal complications somewhat.
The latest evolution in breast reconstruction is “perforator flap surgery”. These techniques use skin and fat from various parts of the body. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. These techniques will be discussed in Part III of this breast reconstruction series.
This post is the first of a 3-part series on reconstructive breast surgery discussing the reconstructive options available to women facing mastectomy for breast cancer.
Every woman has a right to breast reconstruction. This has now actually become a federal mandate and insurance companies have to cover all types of breast reconstruction by law. Having said that it is also important to remember that its not up to the health insurance to decide which reconstruction a woman receives. Thats determined by the patient and her surgeons.
Breast reconstruction is not a form of cosmetic surgery it restores something that nature has provided but cancer has taken away. There is also no age limit as long as there are no medical conditions making the surgery unsafe and the breast cancer is diagnosed at an early enough stage, most women are candidates for the surgery.
Breast reconstruction can be performed as an immediate or delayed procedure. As the term implies, immediate reconstruction is performed immediately after the mastectomy while the patient is still under anesthesia. Once the general surgeon has completed the mastectomy the plastic surgeon begins creating the new breast. Advantages of this approach include the option of preserving most of the breast skin ( skin-sparing mastectomy ) and a shorter scar. The patient also wakes up complete and avoids the experience of a flat chest. Immediate reconstruction provides the best cosmetic results.
Delayed reconstruction generally takes place several months following mastectomy. Patients required to undergo radiation after mastectomy may be advised to delay reconstruction in order to achieve the best results. This delay may last several months in order to allow the tissues to recover as much as possible from the radiotherapy.
There are several reconstructive options, ranging from breast implants to autologous techniques using the patient’s own tissue to recreate a more natural , warm, soft breast. The nipple and areola can also be restored.
This is the most common method of reconstructive breast surgery currently being used in the United States. Most surgeons perform this is a two-stage procedure. The tissue expander is essentially a temporary breast implant which can be placed either at the same time as the mastectomy or after the mastectomy has healed. The expander is used to stretch the skin envelope and recreate the size of breast the patient wants. The expander is ultimately replaced by a permanent implant (saline or silicone) at a separate procedure several months later.
Some patients undergoing immediate breast reconstruction are candidates for one-step breast implant reconstruction whereby a permanent implant is inserted at the time of the mastectomy and the patient avoids going through the whole expansion process. In the one-step implant reconstruction the implant is completely covered by the pectoralis muscle and Alloderm (a cadaveric acellular dermal graft). This is specially treated skin from a cadaver that is used to provide a sling and coverage of the lower part of the implant.
Two types of implants are available to patients: saline and silicone. There are many opinions regarding both types of implants and it is advised that you speak with your surgeon as to which implant would be best for you. Patients who undergo implant reconstruction should be aware that their breast implants may need to be replaced at a future date.
Implant reconstruction can be the best option for some patients. However, tissue expanders and implants can be fraught with complications long-term, particularly if the patient has had or is going to have radiation therapy as part of her cancer treatments. For these reasons, many surgeons and patients prefer autologous reconstruction, i.e. reconstruction using the patient’s own tissue taken from another part of the body. These will be discussed in upcoming posts.
A study published in the November issue of the International Journal of Radiation Oncology*Biology*Physics examined the effect of radiation therapy on different methods of immediate breast reconstruction surgery. For breast cancer patients who receive radiation therapy after a mastectomy and immediate breast reconstruction, autologous tissue reconstruction (ie reconstruction using their own tissue) provides fewer long-term complications and superior cosmetic results than breast reconstruction with a tissue expander and subsequent breast implant.
Many women choose to undergo breast reconstruction surgery at the same time as their mastectomy procedure (under the same anesthetic). This avoids many of the psycho-social issues women face when dealing with a flat chest after mastectomy alone. However, frequently radiation can negatively affect the outcome of reconstruction and increase the risk of long-term complications.
Radiation therapy is increasingly becoming the standard of care for high-risk breast cancer patients after mastectomy in an attempt to decrease local cancer recurrence. However, this can cause a problem for both patients and their radiation oncologists.
Researchers at the Department of Radiation Oncology at Long Island Radiation Therapy in Garden City, N.Y., the Department of Surgery at Long Island Jewish Hospital in New Hyde Park, N.Y., the Department of Surgery at North Shore University Hospital in Manhasset, N.Y., and the Department of Surgery at Winthrop University Hospital in Mineola, N.Y., looked at whether the type of reconstruction performed in women receiving radiation after a mastectomy had an impact on their long-term outcomes.
Two general types of breast reconstruction are available for patients facing mastectomy for breast cancer: autologous tissue reconstruction utilizing the patient’s own tissue (eg DIEP flap, GAP flap, TRAM flap, or latissimus flap) transferred to the chest to recreate the breast(s); and tissue expander/implant reconstruction which involves placement of an inflatable tissue expander (temporary saline implant) and exchange for a permanent implant (saline or silicone) at a separate procedure later on.
This study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and postmastectomy radiation therapy. Ninety-two patients were observed for a period of 38 months following breast reconstruction and radiation therapy.
Researchers found that autologous breast reconstruction is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than tissue expander/implant reconstruction.
None of the 23 patients reconstructed with their own tissue required further surgery while 33% of tissue expander/implant patients needed surgery to correct a problem with their reconstruction. Eighty-three percent of autologous reconstruction patients reported acceptable cosmetic results, as opposed to only 54% of implant patients.
“This study is useful for patients who are candidates for either [method of reconstruction] and are making a decision with regards to reconstruction technique,” Jigna Jhaveri, M.D., lead author of the study and a radiation oncologist at Advanced Radiation Centers of New York in Hauppauge, N.Y., said. “Our study provides evidence that patients who undergo autologous tissue reconstruction and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo tissue expander/implant reconstruction and radiation therapy.”
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Here’s my take….
While some plastic surgeons will disagree with this statement I strongly believe that breast implants and radiation therapy do not get along (at all). I feel the complication rate in implant-reconstructed women receiving radiation therapy is very high, particularly long-term. The handful of women that “do fine” in the short-term will very frequently end up with hard, uncomfortable breasts as the irradiated tissue firms-up over time and squeezes down on the implant. In my opinion the re-operation rate is too high for tissue expander/implant reconstruction to be offered as a routine option when radiation is on the table. This study confirms that breast reconstruction using the patient’s own tissue is far safer than tissue expander/implant reconstruction in women facing radiation therapy after mastectomy.
