Facing a breast cancer diagnosis comes with a series of difficult decisions—including when and how to approach reconstruction if radiation is part of your treatment plan. If you’re considering DIEP flap reconstruction and need radiation, timing is everything.
Understanding your options and asking the right questions can help you avoid complications and achieve the best long-term results.
Should You Delay DIEP Flap Surgery if You Need Radiation?
Great question! If you are anticipating radiation treatments as part of your breast cancer treatment after your mastectomy, most plastic surgeons recommend that DIEP flap reconstruction be delayed until after radiation. Radiation after any tissue (flap) reconstruction can create complications in the newly reconstructed breast: the reconstructed breast can shrink and become firmer. The overlying skin can also develop permanent color changes (hyperpigmentation). These changes create obvious differences in breast symmetry, often requiring further surgery to correct.
Why Radiation After DIEP Flap Can Be Complicated
Immediate DIEP flap breast reconstruction can still be performed if post-mastectomy radiation is planned; however, a coordinated team approach involving a radiation oncologist experienced in treating breast reconstruction patients is key in decreasing the risk of complications.
What Is Delayed-Immediate Breast Reconstruction?
If you are interested in flap breast reconstruction (using your own tissue) and are scheduled to have radiation, you may be a candidate for “delayed-immediate” reconstruction. This approach involves placing and filling a tissue expander at the time of the mastectomy, then proceeding with radiation treatments. This allows preservation of most of the breast skin (skin- or nipple-sparing mastectomy), which typically improves the final cosmetic result. After the radiation therapy is completed, the tissue expander is removed, and the definitive tissue reconstruction is performed.
Our PRMA surgeons do not have a specific preference on how patients receiving radiation choose to proceed. However, it is important to weigh the pros and cons of delayed-immediate reconstruction before proceeding with surgery.
Immediate vs. Delayed DIEP Flap: Pros and Cons
Pros:
- Preserves as much of the skin envelope as possible and takes advantage of the aesthetic benefits of a skin-sparing mastectomy.
- Emotional benefit of avoiding the experience of living without a breast.
- Keeps all options open.
Cons:
- Increased risk of complications during radiation, like infection, skin breakdown, and need for removal of the expander (i.e., more surgery).
- Depending on the radiation oncologist’s preference, the tissue expander may be temporarily (partially) deflated before starting radiation and reinflated after radiation is completed.
Approach | Pros | Cons |
Immediate Delayed | Fewer surgeries, emotional benefit | Higher risk if radiation is required |
Delayed DIEP | Avoids radiation damage to the flap | Temporarily without a breast |
Delayed-Immediate | Preserves the skin envelope, avoids going flat | Expander risks, more surgeries |
It is important to remember that breast reconstruction is not a cookie-cutter procedure. Every woman is unique, and there are options available to meet the specific needs of each individual. If you know radiation treatments will be necessary, and are interested in the DIEP flap breast reconstruction, discuss your options with your doctor to decide what plan of action is best for you.
What to Know About Tissue Expanders with Radiation
Tissue expanders are often used in delayed-immediate reconstruction to preserve the breast skin after mastectomy, especially when radiation is planned. However, radiation can affect the skin and tissue surrounding the expander, increasing risks such as tightness, irritation, or infection. Sometimes the expander may need to be partially deflated during treatment and then re-inflated afterward to prepare for the final DIEP flap surgery.
At PRMA, we coordinate closely with your radiation oncologist to manage these challenges and support the best long-term results. Our team closely monitors your healing throughout the process to help reduce complications and enhance your final outcome. Ask your surgeon how radiation might affect your timeline and what steps will be taken to protect your reconstruction.
Explore Personalized Breast Reconstruction Options at PRMA in San Antonio
If you’re facing radiation and considering DIEP flap reconstruction, the team at PRMA Plastic Surgery in San Antonio offers advanced options tailored to your unique journey. Whether you choose immediate, delayed, or delayed-immediate reconstruction, we’re here to help you understand your choices and feel confident moving forward.
Our specialized microsurgeons work closely with your entire care team to support both your health and your desired results. Request a consultation to learn how PRMA can guide your reconstruction with expert care and personalized support.
