Should Immediate Autologous Breast Reconstruction Be Performed in Women Needing Radiation Therapy?
By: Courtney Floyd
Breast reconstruction and radiation do not mix well. In fact, recent studies show 1 in 3 implant reconstructions fail when radiation is in the mix. But what about autologous reconstruction procedures like the DIEP flap? A study published in Plastic and Reconstructive Surgery took a closer look.
The study compared both immediate and delayed autologous reconstruction patients who had radiation. Initially, immediate reconstruction patients reported higher levels of satisfied with their breasts and psychosocial and sexual well-being. After one and two years, both groups of patients reported similar satisfaction reports. The study concluded immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy appeared to be a safe option for select patients and centers . Breast aesthetics and quality of life, evaluated from the patient’s perspective, were not compromised by flap exposure to radiation therapy.
For additional insight, I reached out to PRMA’s Dr. Minas Chrysopoulo:
"When radiation is planned as part of breast cancer treatment after mastectomy, most plastic surgeons recommend delaying tissue (flap) reconstruction until after the radiation therapy has been completed. Radiation after any flap reconstruction can create complications in the newly reconstructed breast: the breast can shrink and develop fat necrosis leading to areas of firmness. The overlying skin can also develop permanent color changes (hyperpigmentation). These changes create obvious differences in breast appearance and symmetry often requiring further surgery to correct. In severe cases, more serious complications such as partial flap loss and the creation of new wounds can require further flap reconstruction. Thankfully, radiotherapy techniques and protocols have improved over time and these more serious complications are rare.
Several studies have illustrated the importance of a team approach in high volume specialist centers when it comes to improving outcomes for certain complex procedures like perforator flap breast reconstruction. While this study illustrates that immediate flap breast reconstruction can certainly be an option even if post-mastectomy radiation is planned, a coordinated team approach involving a radiation oncologist very experienced in treating breast reconstruction patients is vital for making this a viable option and decreasing the risk of complications."