Do you recommend breast implants after a lumpectomy and radiation? If so, what type of implants and what are the pros and cons of this type of surgery? I had the lumpectomy/radiation a year ago. My breast tissue is soft and most of the discoloration is gone. Are there studies I can read? Thank you.
Breast Implants After Lumpectomy and Radiation?
Doctor Answers (33)
Breast reconstruction with implants following breast cancer reconstruction
Here is a layman and succint explanation of the issues:
However, in summary, there are an increased risk of complications. Generally most surgeons prefer to use your own vascularized tissues .
Implants after Lumpectomy and Radiation
Implants after lumpectomy and radiation
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Breast implants and radiation can be a difficult combination!
Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.
If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. Please choose your surgeon carefully. Read their reviews to evaluate how their patients feel about their experience. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+
Implants after lumpectomy with radiation
Generally speaking, we try to avoid operating on radiated breast tissue because of the higher risk of wound healing problems, infection, and scar tissue formation. This is secondary to the decreased blood flow through this tissue.
For this reason, we try to avoid performing breast lifts, breast reductions, or breast augmentations after radiation. This is an area of breast surgery that needs more research. I frequently see women with previous breast augmentations, undergo lumpectomy and radiation to subsequently develop capsular contracture. At this point, it is a very difficult problem to fix. However, if they had undergone a nipple sparing mastectomy and implant reconstruction, the radiation could have been avoided in most cases.
Bottomline, radiation is a risk factor for any type of plastic surgery, especially breast augmentation afterwards. I would caution against this as the risks may easily outweigh the reward.
Increased complication rate for breast augmentation following radiotherapy
Radiotherapy permanently and progressively impairs the healing ability of tissues in the body. For patients wanting an augmentation after lumpectomy/radiotherapy, I recommend putting the implant in a submuscular plane AND transferring the latissimus dorsi muscle (large back muscle) from the back to the chest to cover the lower pole of the implant. This way, the implant is wrapped in muscle with a good blood supply and this will hopefully decrease the incidence of complications such as infection, extrusion, wound healing probelms and capsular contracture.
There was a recent study published in the journal PRS which looked at the use of acellular dermal matrix to cover the tissue expander/implant in patients who had previously had chest wall radiotherapy and were now undergoing mastectomy/immediate recon. This study found an acceptable complication rate without the increased surgery and scarring of a latissimus dorsi flap.
I hope this helps.
Breast Implants After Lumpectomy and Radiation
In general, breast implants do not work well in radiated fields. You may be able to get an implant in but it is doubtful that it will be as natural as the non-irradiated side. There are studies by some surgeons claiming good success in selected patients, but my sense is that their definition of success and mine are very different.
Implants following lumpectomy and radiation
Contour deformities or asymmetry between size/shape of the other breast following lumpectomy and radiation may occur after everything settles. There are several options to ameliorate this and you should discuss your options with your plastic surgeon to determine which option would be best for you. It is recommended to wait approximately one year after your radiation therapy is completed before considering any reconstructive procedure on the breast.
Typically, implants in the setting of an irradiated breast has higher rates of complication, including infection, wound complications, capsular contracture, etc. Many surgeons, including myself, have placed implants to improve symmetry in these instances with excellent results. However, if your deformity is a contour issue with a soft tissue deficiency, placing an implant beneath the breast may actually worsen the deformity as it is not addressing the issue to "fill" the defect. For such problems, it may be a wiser decision to consider fat grafting for smaller defects, where fat is harvested for another area of your body and then reinjected into the defect, thus adding volume as well as having the added properties of fat graft stem cells. Autologous flaps such as local tissue, TAP, or LDMF may be needed for larger soft tissue defects.
Breast reconstruction after lumpectomy
Breast reconstruction either with implants or autogenous tissue can be performed after lumpectomy and radiation. Most lumpectomy procedures do not require any reconstruction though. Please visit with a board certified plastic surgeon for a detailed exam and evaluation.
Implants alone and radiation not advised
In my practice, I would never advise implants alone in a breast that has been radiated. There are too many documented complications and in my eyes, the risks are not acceptable. You could consider using your back muscle with an implant, or a DIEP flap (takes tissue that would be discarded in a tummy tuck and uses it to reconstruct breasts). In a radiated field that procedure works great. My patients love the fact that they get a tummy tuck, AND experience no loss of the abdominal muscle. Your should visit with a plastic surgeon that offers all types of reconstruction so that you get a balanced view. You may or may not be a candidate for certain types of breast reconstruction but that can only be assessed by an examination.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.