Recently, Dr. Chrysopoulo and breast cancer survivor Erika sat down to discuss the impact of radiation on breast reconstruction. We covered a lot during the Facebook LIVE event and we don’t want anyone to miss out on the valuable information discussed. Check out the replay below or read more on the hot topics discussed below.

What type of reconstruction is recommended when radiation is planned?

There are many options for breast reconstruction available today. When radiation is planned, breast reconstruction using your own tissue is strongly preferred instead of implants for many reasons. At PRMA, we believe the DIEP flap is today’s gold standard for breast reconstruction.

What are the benefits of tissue (or autologous) reconstruction after radiation?

With autologous reconstruction, a soft, warm and natural breast is created. All damaged tissue is removed and replaced with healthy tissue from the donor site. The results look and “feel” like a natural breast. Sensory nerve reconstruction can also be performed to help patients regain more sensation following the mastectomy.

When tissue expanders and implants are used, the damaged radiated skin cannot be replaced but instead has to be stretched. Unfortunately, the radiated skin can become quite firm and very often does not stretch well. This increases the risk of complications – when radiation is in the mix, almost 1 in 3 implant reconstructions fail and the patient is left without a breast. Flap procedures like the DIEP flap have a much higher success rate, over 99% in fact at PRMA

When is the best timing for breast reconstruction after radiation?

Many reconstructive surgeons prefer to delay breast reconstruction when radiation is part of the treatment plan. Most patients are told they should wait 6 months to a year before proceeding with reconstruction. However, at PRMA we have found undergoing tissue-based reconstruction with a flap as early as 6 weeks after radiation is safe. In fact, for some patients it is preferred. The longer a patient waits to undergo reconstruction after radiation, the greater the amount of scarring that can develop. By performing a flap reconstruction sooner, we interrupt the scarring process early on by re-introducing healthy tissue to create a warm, soft breast.

Immediate DIEP flap breast reconstruction (at the same time as the mastectomy) can still be performed if 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 if a patient finds out they need radiation during a mastectomy with immediate DIEP flap reconstruction?

This is not an ideal situation, but there are options. One option is to proceed with reconstruction then refer to a radiologist who has extensive experience in radiating DIEP flap patients. Another option is to place a tissue expander to get the patient through the radiation therapy while preserving as much of the breast shape as possible. The tissue expander can then be replaced with the DIEP flap after radiation is completed. This staged approach is known as “delayed-immediate” reconstruction. It is important to ask your surgical team about their protocol in this situation before surgery.

Can implants be removed and replaced with DIEP flap after radiation?

Absolutely! Patients who are unhappy with their previous implant reconstructions frequently come to PRMA for this very reason.

If a male breast cancer patient undergoes radiation, what breast reconstruction options are available?

Fat grafting is the most common form of breast reconstruction for men. After radiation, fat grafting would still be recommended, but it may take more than one procedure to achieve optimal results. In extreme cases, flap procedures can be performed to replace the damaged radiated tissue with healthy, soft tissue, usually from the back (latissimus flap).

Remember you are your own best advocate! It is important to discuss all your options with your surgical team and through shared decision making decide what is best for you.

Author: Dr. Minas Chrysopoulo and Courtney Floyd