Breast Reconstruction With Tissue Much Safer Than Implants When Radiation Planned After Mastectomy
By: Dr. Minas Chrysopoulo
A study published in the November issue of the International Journal of Radiation Oncology-Biology-Physics examined the effect of radiation therapy on different methods of immediate breast reconstruction surgery.
For breast cancer patients who receive radiation therapy after a mastectomy and immediate breast reconstruction, autologous tissue reconstruction (ie reconstruction using their own tissue or "flap") provides fewer long-term complications and superior cosmetic results than breast reconstruction with a tissue expander and subsequent breast implant.
Many women choose to undergo breast reconstruction surgery at the same time as their mastectomy procedure (under the same anesthetic), known as "immediate reconstruction". This avoids many of the psycho-social issues women face when dealing with a flat chest after mastectomy alone. However, frequently radiation can negatively affect the outcome of reconstruction and increase the risk of long-term complications.
Radiation therapy is increasingly becoming used in high-risk breast cancer patients after mastectomy in an attempt to decrease the risk of local cancer recurrence.
Researchers at the Department of Radiation Oncology at Long Island Radiation Therapy in Garden City, N.Y., the Department of Surgery at Long Island Jewish Hospital in New Hyde Park, N.Y., the Department of Surgery at North Shore University Hospital in Manhasset, N.Y., and the Department of Surgery at Winthrop University Hospital in Mineola, N.Y., looked at whether the type of reconstruction performed in women receiving radiation after a mastectomy had an impact on their long-term outcomes.
Two general types of breast reconstruction are available for patients facing mastectomy for breast cancer: autologous tissue reconstruction (flap) utilizing the patient's own tissue transferred to the chest to recreate the breast(s); and tissue expander/implant reconstruction which involves placement of an inflatable tissue expander (temporary saline implant) and exchange for a permanent implant (saline or silicone) at a separate procedure later on.
This study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and postmastectomy radiation therapy. Ninety-two patients were observed for a period of 38 months following breast reconstruction and radiation therapy.
Researchers found that flap breast reconstruction is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than tissue expander/implant reconstruction.
None of the 23 patients reconstructed with their own tissue required further surgery while 33 % of tissue expander/implant patients needed surgery to correct a problem with their reconstruction. Eighty-three percent of autologous reconstruction patients reported acceptable cosmetic results, as opposed to only 54 % of implant patients.
"This study is useful for patients who are candidates for either [method of reconstruction] and are making a decision with regards to reconstruction technique," Jigna Jhaveri, M.D., lead author of the study and a radiation oncologist at Advanced Radiation Centers of New York in Hauppauge, N.Y., said. "Our study provides evidence that patients who undergo autologous tissue reconstruction and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo tissue expander/implant reconstruction and radiation therapy."
This study confirms that breast reconstruction using the patient's own tissue is safer than tissue expander/implant reconstruction in women facing radiation therapy after mastectomy.