Radiation and Breast Reconstruction with Implants
By: Dr. Gary Arishita
It is estimated that in 2013, more then 232,000 women will be diagnosed with invasive breast cancer with over 64,000 being diagnosed with in-situ disease. Of these women, half will be treated with lumpectomy and radiation treatments.
Radiation is an essential part of treatment for some women. Risk of recurrence and death can be significantly reduced with radiation in women undergoing lumpectomy. In locally advanced breast cancers, radiation can also be necessary after mastectomy.
Radiation works by damaging cellular DNA. Cells that are rapidly dividing are damaged more by radiation than normal cells. The beneficial effects of radiation following lumpectomy have been well proven. In the vast majority of cases, lumpectomy is not an acceptable treatment for breast cancer unless radiation is added as the breast cancer recurrence rate is too high after lumpectomy alone.
Radiation has deleterious effects on normal breast tissue as well. The radiation causes permanent changes to the normal breast tissue. It causes fibrosis of the tissues and decreases elasticity. The breast feels tighter and the skin and underlying tissues are less "stretchy". The microvascular circulation is damaged and blood flow is reduced. These effects are present in the breast and skin forever. The changes can be more pronounced in some patients, but all treated tissues are affected.
Radiation increases the risk of complications and poor outcomes in breast reconstruction. When tissue expander and implant reconstruction is used after radiation, major complications occur in about half of patients. A major complication usually means that more surgery was needed and the implant had to be removed. It is then more difficult to perform reconstruction in tissues that have been scarred by infection or wound breakdown in addition to the radiation. Some plastic surgeons offer implant reconstruction to patients that have been previously treated with radiation. They cite data showing that it can sometimes work. The early results can sometimes appear good but less than half of patients will have an acceptable reconstruction long-term.
I do not recommend attempting tissue expander or implant reconstruction in patients who have been previously treated with radiation. I believe that a 50% complication rate is too risky. If the reconstruction fails, it is even more difficult to get a great result. I recommend that a tissue flap be used for reconstruction following radiation. When transplanting healthy, non-irradiated tissue to the breast, the flap behaves more like normal tissues and the health of the surrounding tissues improves significantly.
Tissue can be taken as a flap from the abdomen, the back, the buttock, or the thigh. Often the reconstruction can be made entirely of transplanted flap tissues. In patients who do not have enough tissue available, I use a combination of a flap along with a tissue expander or implant. The addition of the healthy flap to the radiated breast improves the overall health of the tissues and allows use of implants. Healing is improved and the cosmetic appearance of the breast is better when a flap is used along with an implant.
There are always choices in treatment. This applies to cancer treatment as well as reconstruction. I strongly recommend looking at your options and the short and long term impact of those treatment choices.
I hope this helps.