Radiation and Breast Reconstruction with Implants

By: Dr. Gary Arishita

Blogs

Is implant breast reconstruction safe after radiation therapy? 

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.

Is implant breast reconstruction safe after radiation therapy?

Learn More About DIEP Flap Breast Reconstruction

61 Comments

(The content of this field is kept private and will not be shown publicly.)


  • PRMA Plastic Surgery

    Capsular contracture can be corrected temporarily by removing part of or the entire capsule and placing a smaller implant; however, due to the long-lasting effects of radiation, the risk of contracture and migration of the implant is high. Tissue that has been radiated tends to tighten over time (no matter if it has been days, weeks or even years since the last treatment). This causes the implant to shift upward on the chest, moving to where it has least resistance, and oftentimes causing the capsule to contract.

    Reply
  • Staci

    This is exactly my worry! I also received implants in 2006. Just had my lumpectomy and am supposed to start radiation now. What was your outcome and how are you doing? smile

    Reply
  • PRMA Plastic Surgery

    Hello Staci! If you do experience adverse side effects after radiation therapy, you may consider replacing the implants with a tissue flap breast reconstruction such as the DIEP flap. It is always best to consult with a board certified plastic surgeon. You are more than welcome to fill out our virtual consultation form and one of our surgeon can provide you with recommendations. You can find the form at http://prma-enhance.com/patient-forms/virtual-consultation

    Reply
  • Maureen

    I’ve had two lumpectomyies followed with a Mastectomy and now facing the beginning of chemo on the 29th My surgeon and Chemo Dr said I would not need radiation and I am going thru reconstruction of the breast with an expander in me now - then the radiation Dr now says she advises radiation also for 6 weeks due to the most recent studies. My tumor was not 5 cm but I did have 2 positive lymph nodes out of 11 that were removed. I do not want problems with the reconstruction plastic surgery and plan to talk with my chemo Dr again but I don’t believe I need the radiation in addition to chemo. Please respond with advice if you are knowledgeable. Thank you.

    Reply
  • PRMA Plastic Surgery

    Good morning Maureen. It is best for you to follow the advise of your treating cancer physicians. Your health comes first and reconstruction comes second. If you are worried about complications with implants and radiation, you may want to consider a flap based reconstruction surgery. You can find more information at http://prma-enhance.com/breast-reconstruction/diep-flap

    Reply
  • Suzanna

    Hello I am writing because I have a healing problem on my radiated left breast. I had radiation 8 years ago on the left breast, I was diagnosed again with breast cancer on my right Aug 2014.I had both breast removed, I dad my expanders removed and implants put on Oct 2015, now all of a sudden 2 months later I see my radiated side is getting a scab on it, my surgeon put me on Hyperbaric Oxygen therapy this is my first week, but today I see a little pink on the radiated side, what do you think is going to happen to me also I started antibiotic today. I also have 30 more hyperbaric sessions left. Thank you Suzana

    Reply
  • PRMA Plastic Surgery

    Hello Suzana! Without knowing your full medical history and evaluating the redness it is hard to make a clinical diagnosis. Radiation can cause complications, even after reconstruction. I would continue with the treatments your physician is recommending and then evaluate your options after.

    Reply
  • Diane

    I had a a lumpectomy and radiation in 2009. Now, a surgeon wants to do another lumpectomy for a lump he feels. I think the lump is just a side effect of radiation. Is it safe to do another lumpectomy? What tests should the doctor order first?

    Reply
  • PRMA Plastic Surgery

    Thanks so much for reaching out Diane! It is difficult to recommend a treatment plan without a full evaluation of your history with a physician. If you feel you need a second opinion before proceeding with another lumpectomy, I would recommend contacting an oncologist in your area. I hope you find this helpful.

    Reply
  • Mai

    I’m 28 turning 29 this saturday. I have my right breast removed and finished chemo. I’m now at the radiation and reconstruction stage. I don’t know what to do first. I can choose to do radiation then reconstruction using diep flap. Our I can choose implants then radiation. I’m scared and have read up on the pros and cons. I need help in deciding. I’m still young and I’m scared of the decision that I’ll be making.

    Reply
  • PRMA Plastic Surgery

    Hello Mai and thanks so much for reaching out to PRMA. Deciding between DIEP flap or implant breast reconstruction is a personal decision that should be made with the assistance of a board-certified plastic surgeon. There are pros and cons for each, but at PRMA, we typically prefer tissue flap breast reconstruction techniques (like the DIEP) anytime radiation is used for treatment.

    Reply
  • Monica

    I was recently diagnosed with stage 1 BC and I’m scheduled for a lumpectomy with lymph nodes removal later this week, and then radiation after. On top of my worrying about having a successful clear margins lumpectomy and having normal lymph nodes, I’m also worried about my silicone implants that I’ve had since July 2008. I’ve never had any complications with them but now I’m worried about possible side effects during and after my radiation treatments. I’ve read about the implant feeling hard or the implant moving higher up on your chest, shrinking, etc. What do I need to do or should I just wait and see what happens after radiation and not worry about it now? Thanks!

    Reply
  • PRMA Plastic Surgery

    Good morning Monica! I am so sorry to hear you are in this predicament! It is true that radiation and implants typically do not work well together. Usually the radiation damage causes the breast tissue and skin to change which results in dramatic differences between your breasts and usually requires additional surgery later down the road. We truly would recommend for you to seek a second opinion before proceeding. In fact, we recommend that to all of our patients if they are unsure about what to do. You are more than welcome to fill out our free virtual consultation form at http://prma-enhance.com/patient-forms/virtual-consultation or you can give our office a call at 800.692.5565. One of our board-certified surgeons would be more than happy to discuss your options with you! Hope to hear from you soon!

    Reply
  • Tamara

    Hello , in 2013 I was Dx with stage3c inflammatory breast cancer. I had all the usual, chemo, bmx with tissue expanders and radiation. I opted to do diep as advised. No true complications but I am dissatisfied with my results shape wise. So my concern from day one with the tissue expanders I had 9 months of constant pain! After diep the pain decreased about 80%. So now after 2fat grafting sessions my surgeon is recommending small silicone implants (tear drop shape I believe) above the muscle not underneath based on my experience with the TE. Surgery is scheduled for July 5th,2016. I’m caught between knowing what would be less painful in the long run vs risk of capsulation as well as the overall look. By the way it’s the projection ( or lack of that I’m displeased with) . Next is do I seek out another surgeon ( PRMA who does this all the time) or continue with my surgeon in California who has done 101 total diep with only one failure. Ultimately I know it’s my choice but would love your thoughts on this. I’m just so tired of surgeries , I’m hoping for this to be my last one!

    Reply
  • PRMA Plastic Surgery

    Hey Tamara! We would be more than happy to do a virtual consultation with you if that is something you may be interested in. This way you can get a second opinion from us before your scheduled surgery in July. You can fill out our virtual consultation form at http://prma-enhance.com/patient-forms/virtual-consultation and our patient liaison will connect you with one of our board-certified surgeons. I do hope we hear from you soon!

    Reply
  • Vicky

    Hi, I had a mastectomy 9 weeks ago. Expander, 240 cc fill. Doing great, full range, all looks great. Second surgery to remove expander and put in silicone implant, fat grafting from thights, lift normal breast on July 1. Radiation to start Aug. 1. What can I expect? PS knows implant may tighten and lift and plans to adjust his July 1implant placement anticipating that. Will I be ok? I do not want a third surgery! What can I do to insure success on my part?

    Reply
  • PRMA Plastic Surgery

    Hello Vicky! Unfortunately, radiation and implants typically do not go well together. We usually advise to wait until after radiation is complete before proceeding with reconstruction. If you are unsure about the plan your plastic surgeon has in place for you, I would recommend seeking a second opinion.

    Reply
  • Vickie

    I have had breast cancer and had radiation…..( on my right )....I had stage 3…... They did a lumpectomy ...It was a very large mass on the top half….Now my breast are 2 different sizes… One is a little over a D and the other side is now a B…. I went to the DR… the other day to talk to him about doing something…..I’m not to sure what I want….. I was thinking about making the size D to a C and the B to a C….The DR is not to sure about doing anything to the B breast ...Because I had radiation ...He thinks its to much of a risk because of the radiation ...I’m not sure if to take the risk or go a different rout.

    Reply
  • PRMA Plastic Surgery

    Thank you for sharing Vickie and I am so sorry to hear you are experiencing this. We would recommend seeking a second opinion to learn more about your options. We would be more than happy to consult with virtually! We offer a free virtual consultation form at http://prma-enhance.com/patient-forms/virtual-consultation. You can also give us a call anytime at 800.692.5565

    Reply
  • Wendy

    I had breast cancer with a lumpectomy and radiation 11 years ago. I was just diagnosed with dcis in the same breast. The recommendation is to do mastectomy with tissue expanders and diep flap in a few months. Does this seem reasonable?

    Reply
 < 1 2 3 > 
PRMA Plastic Surgery