Breast Cancer Recurrence Not Influenced By Method Of Breast Reconstruction
By: Dr. Minas Chrysopoulo
One of my out-of-state breast cancer patients called me today. She recently underwent bilateral mastectomies and immediate breast reconstruction with DIEP flaps. She recovered very well from the surgery but unfortunately her final pathology results showed that she would likely benefit from radiation therapy.
She explained to her radiation oncologist that she was worried the radiation therapy would ruin her DIEP flap reconstruction. While there are certainly things we can do to address this, she is right to be concerned - patients undergoing radiation therapy after an autologous reconstruction (a flap reconstruction using their own tissue) have a significant risk of needing further surgery to correct asymmetry caused by the radiation changes (usually firming and shrinking) of the irradiated breast.
The response she received from the radiation oncologist baffled me.... "DIEP flap? What's a DIEP flap?.... if you'd had a TRAM flap then you wouldn't be needing radiation."
This is an incorrect statement.
The type of breast reconstruction has absolutely nothing to do with it. The TRAM flap and DIEP flap both use lower abdominal skin and fat to reconstruct the breast; the main difference between these procedures is that the TRAM also includes the abdominal muscle while the DIEP preserves it.
The pathology report and the recommendation for radiation therapy would have been exactly the same whether reconstruction was performed or not. The risk of cancer recurrence is related to the characteristics of the cancer itself and the mastectomy margins, not the method of reconstruction.
So what's the take home message if you're considering breast reconstruction? Choose whichever method of reconstruction is best for you. Your decision will not in influence the risk of additional cancer treatment or the likelihood of your cancer coming back in any way.