Breast Reconstruction Failure Rates After Radiation: Implants vs DIEP flap

By: Courtney Floyd

Blogs
April 06, 2017

Implant breast reconstruction continues to be the most widely performed method of reconstruction to date, but it may not always be the best option.

A recent study published in Plastic and Reconstructive Surgery compared complications after implant and autologous (tissue) breast reconstruction in patients who had radiation therapy. The study included 4,781 patients. Of the patients who had implanted-based surgery, 29.4% resulted in failed reconstruction resulting in more surgery such as removal of the implant.  However, patients choosing autologous based surgery (using their own tissue) only saw a 4.3% failure rate.

“This article shows an unfortunate trend in reconstructive breast surgery, namely our specialty's over-reliance on breast implants” says PRMA's Dr. Gary Arishita. “We have known for many years that performing implant reconstruction in a radiated breast is associated with a significantly increased risk of re-operation and reconstructive failure. Despite this fact, implant reconstruction remains the most common method of reconstruction in radiated patients. This article adds to the existing body of peer-reviewed, published data supporting autologous reconstruction instead of implants in the setting of radiation. I don’t believe an operation with a 29% failure rate is an acceptable option, especially when our success rate for flap reconstruction is over 99% in the radiated patient. Ultimately, my patients decide what they want to do regarding reconstruction and I present the data to assist them in making their decision. This article will be useful in helping my patients decide how to proceed.”

So, what’s the take home message? Implants and radiation do not mix well. A 29% failure rate is far too high in our opinion.

Advanced autologous (flap) procedures like the DIEP flap represent today’s gold standard in breast reconstruction. Unlike implants, the DIEP flap procedure restores a "natural", soft, warm breast after mastectomy.  Tissue can also be removed from other areas of the body depending on the patient's tissue distribution (like the inner thigh, or buttock) and transplanted to the chest, eliminating the need for an implant.  

Most women undergoing procedures like the DIEP flap are also candidates for microneurorrhaphy (a procedure to repair nerves damaged at the time of mastectomy).  This extra procedure performed at the same time as the breast reconstruction provides patients a higher likelihood of regaining some feeling after mastectomy.  Combine these benefits along with the significantly lower risk of failure after radiation, and it is clear why autologous reconstruction techniques may be the better option for many patients.  

Sadly, most women today are not fully informed of all their reconstructive options before undergoing surgery. It’s important for patients to know there are almost always choices, and implants are not the only one.  Take time to discuss all options with your surgeon, and through shared decision making, choose the best reconstruction technique for you.  

breast reconstruction after radiation implant vs diep

Learn More About DIEP Flap Breast Reconstruction

4 Comments

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  • Lisa Minnoe

    Tissue transfer , a lot is discussed about the DIEP surgery, Is there anything wrong with the latissimus dorsi flap? Some patients do not have enough tissue to use the stomache area. They are recommended to have the LAT surgery. Does the body compensate for the loss of both Latissimus muscles. I am not a pro at swimming, tennis or skiing, but do play softball, exercise , push a vacuum and also carry laundry baskets , how much mobility will my body loose? Will I have trouble with shoulders and strength in arms . Will physical therapy help to increase mobility after surgery and put me back to normal or close.

    Thank you,
    Lisa Minnoe

    Reply
    • PRMA

      Latissimus dorsi flap is a good option for some patients who do not have enough tissue for a flap surgery.  However, the tummy is not the only area where tissue can be removed.  Tissue can also be taken from the inner thigh (TUG/VUG) or the buttock area (GAP). 
      If there is any loss of range of motion associated with the LAT flap, physical therapy is a great option to help regain mobility after surgery.

      Reply
  • Lupe Garza

    In 2011 I had Stage 1 IDCIS triple neg and decided on DIEP flap procedure with a breast lift on the other side to match the new reconstructed breast.  I did not need radiation and this procedure leaves you feeling and looking beautiful.  But unfortunately I had a recurrence on the same side of the reconstructed breast in the axillary lymph nodes. Radiation was necessary for the reconstructed breast even though the occurrence was in left armpit nodes, and therefore, I was left with a very hard breast to touch and it also lifted quite a bit too.  That left my good breast looking so low as if though I had not had a breast lift at all.  That being said, I would have benefited delaying my reconstruction till after radiation therapy in my opinion.  Of course no one anticipates getting a recurrence within 6 months and so what are the options for fixing something like this and make it beautiful again?  I guess I fell in the few percentage that get a recurrence on the same side as the DIEP flap reconstructed breast.

    Reply
    • PRMA

      So sorry to hear of your recurrence Lupe! There are options to help correct the damage radiation caused to your reconstructed breast.  We would be more than happy to review your needs and provide you with our surgical recommendations!  You are welcome to set up an appointment by calling our office at 800-692-5565 or you can fill out our FREE virtual consultation form at https://prma-enhance.com/schedule-a-consultation/

      Reply
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