Radiation and Breast Reconstruction with Implants

By: Dr. Gary Arishita

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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

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  • PRMA Plastic Surgery

    Hey Wendy! It is hard to say with this minimal information what we would recommend for you. If you are unsure about your reconstruction plan, we would suggest seeking a second opinion. If you are interested, you can fill out our virtual consultation form and we would be more than happy to evaluate you case. You find the form at http://prma-enhance.com/patient-forms/virtual-consultation

    Reply
  • Cassandra

    Hi my name is Cassandra and I was diagnosed with breast cancer at the age of 28 I had six rounds of chemo and then a double mastectomy with tissue expander placement I am now waiting to have the tissue expanders removed and permanent implants placed but this last fill that I got was very very painful, as were the ones before that. Now i have pain on right side that is radiating down my arm and back. Could this be due to a possible pinched nerve? Everyone keeps saying tissue expanders are uncomfortable but i am hurting so bad and my chest now feels like hard rock.

    Reply
  • PRMA Plastic Surgery

    Hello Cassandra! Thanks so much for reaching out to PRMA. I am so sorry to hear you are feeling so uncomfortable! Tissue expanders are typically uncomfortable. The pain and discomfort in your chest that you are experiencing should be discussed with your surgeon as soon as possible so he/she can make sure there are no complications.

    Reply
  • Toni

    I am in the same situation. I feel like someone put a rock on my chest. It’s tight and it hurts and looks awful!

    Reply
  • PRMA Plastic Surgery

    Hate to hear you are experiencing this Toni! Sadly, when radiation is involved, patients with implants can experience a lot of complications. We typically recommend removing the implants and replacing them with living healthy tissue from another area of the body. Our most commonly performed procedure is the DIEP flap. The DIEP flap uses the patient’s own abdominal skin and fat to reconstruct a natural, warm, soft breast after mastectomy. Unlike the TRAM flap, the DIEP preserves all the abdominal muscles. Only abdominal skin and fat are removed similar to a “tummy tuck”. Saving the abdominal muscles means patients experience less pain, enjoy a faster recovery, maintain their core strength long-term, and have a lower risk of complications. If you are interested, we would be more than happy to discuss your options with you further! You can reach us at 800.692.5565 or at .(JavaScript must be enabled to view this email address)

    Reply
  • Edgar

    Sorry to hear about your situation. Hope you will get well soon. Take care.

    Reply
  • Sabrina

    Hi. In 2014 my right breast was diagnosed with stage 1 breast cancer, so I had a lumpectomy followed by 6 weeks of radiation. My right breast shrank and I experience the asymmetry. In 2016, After having a benign mass now in the left breast, my doctors performed a double mastectomy, followed by the DIEP using my stomach tissue. I am healing from the DIEP, but disappointed because my breasts are still assymetrical, with the right breast still being smaller and now darker again and hard. According to the surgeon , the size is still small because my right breast had been radiated in 2014; however, my purpose in even doing the DIEP was to bring size to the radiated breast and symmetry to both. What would be your recommendations to achieve those results now that I’ve already had the DIEP?—Disappointed Sabrina.

    Reply
  • PRMA Plastic Surgery

    Thanks for reaching our Sabrina! Typically, the DIEP flap is followed by a revision surgery to correct any symmetry issues. It is difficult to say specifically what we would recommend without consulting with you, but additional fat grafting on the smaller breast or a reduction surgery on the larger breast are both options that could help make the breast more symmetrical. We would be more than happy to review your situation and see what we could do to help. You are welcome to fill out our FREE virtual consultation form at http://prma-enhance.com/patient-forms/virtual-consultation and one of our surgeons would be happy to review and provide you with their recommendations. Hope this information helps!

    Reply
  • Justina

    Why is it that the expander doesn’t sail when it’s in your radiator breast that soon as you get an implant it fails what is the difference in expander and implant

    Reply
    • PRMA

      Hello Justina!  Every case is different. For some, complications begin with the tissue expanders.  Some patients may not experience complications until the final implant is placed, and others may never experience any complications.

      Reply
  • Jennifer Darling

    I had ductstal carsonona of right breast serger an IORT ( in operative radiation during surgery) at Hoag March 29,2017. Reconstruction and small implants were done. Thinking no other radiation was necessary. But that wade to the case. Margins were to small and I had 29 radiation treatments , July, Aug 2017. The plastic surgine results were great. Not much pain . A month after radiation pain started. October November I had a mammogram and ultrasound to see why I was having pain. Was told it was nerve pain. Everything looked fine. Dec-Jan2018 pain increased and my right breast has shrunk 50% March I had MRI, again told everything looked fine.
    Why do I have pain and why is the breast shrinking. I would think the implant has failed after all that radiation. But they don’t see any problem .
    Where do I go from here.

    Reply
    • PRMA

      So sorry to hear you are going through all of this Jennifer!  It is difficult to say for certain what could be causing your pain and shrinkage without an evaluation, but what you describe does sound similar to common implant related complications following radiation treatments.  We typically recommend replacing implants with your own living through tissue flap procedures like the DIEP flap.  We welcome you to fill out our free virtual consultation form at https://prma-enhance.com/schedule-a-consultation/.  Once received one of our board-certified plastic surgeons can review your needs and provide you with their surgical recommendations all from the comfort of your home. 
      Sending well wishes your way!

      Reply
  • Sara

    Hello, I’m going to have a bilateral mastectomy and they told me I’m going to need radiation after that. I would like to know your opinion about immediate reconstruction with adjustable implants above the muscle and if there is a difference placing the implants above or under the muscle before radiation which according to the doctor it would be 5 weeks after surgery. Thank you

    Reply
    • PRMA

      Hello Sara! Thanks so much for reaching out.  We typically do not recommend implant reconstruction following radiation therapy.  According to the most recent research, about 1 in 3 implant reconstructions fail following radiation treatment.  It is for this reason we recommend reconstruction using your own tissue via procedures like the DIEP flap.  We would be more than happy to consult with you and review your options with you.  You are welcome to give us a call at 800-692-5565 or you can fill out our free virtual consultation form at https://prma-enhance.com/schedule-a-consultation/.

      Reply
  • Christine Shields

    I was not aware of the complications of a breast implant after radiation. I had implants placed in June 2018,2 capsular contractions. The first one was taken out and cleaned and put back in.After that 1st problem, I had blood pooling & 1/2 a bruised breast in lower 1/2 of my breast . Dr said it would go away. I called for a sooner appointment , I had to wait a month.That was suctioned and scraped out and a new implant was put in. That one broke through the lower 1/2 of my breast 2 large holes . It was horrible. That one was removed I am now healing very slowly. It was removed and sewn up with out any implant. That last removal was done January 29th 2019. I am at a loss of what is my next step. That breast obviously cannot handle an implant . I am reading on the DIEP. Do all Plastic Surgeons perform this? Should I risk using The same Dr again?

    Reply
    • PRMA

      So sorry to hear you are going through all of this Christine! 
      We are glad to hear you are researching your options!  It is important to know that not all plastic surgeons perform DIEP flap reconstruction.  It is important to select a surgeon who performs the procedure regularly with a high success rate.  At PRMA, we perform over 700 flaps a year with an over 99% success rate.  If you are ever interested in seeking a second opinion with us, we welcome you to fill out our free virtual consultation form at https://prma-enhance.com/schedule-a-consultation/

      Reply
  • Angel Irvine

    I am 3 days away from being done with radiation. This treatment is for a recurrence AFTER having diep flap with small implants. I’m starting to have some pain in breast that’s treated. Is it too soon to do a virtual consultation to have my radiated side fixed. I want implants removed and symmetry again.
    Thanks for feedback.

    Reply
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