Breast Reconstruction Failure Rates After Radiation: Implants vs DIEP flap
By: Courtney Floyd
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.