Breast Implants After Lumpectomy and Radiation?

It can be difficult to expand or enlarge the breast with an implant after radiation and lumpectomy. The skin and the tissue are frequently sclerotic and will have lost their natural elasticity. Sometimes it is a better choice to make the opposite breast smaller to achieve symmetry.

Unfortunately, surgery of any kind on a radiated breast can be problematic due to increased risk of wound healing problems and infection.  Implants are stressful to the breast in this sense and also have a substantially higher risk of capsular contracture (tightening of tissue around the implant).  The high likelihood of capsular contracture makes it unlikely that a radiated breast augmented with an implant will appear natural or maintain a soft texture.  As a result, augmentation is an intervention that is typically avoided in this setting.

The effects of radiation are different for every woman, and unfortunately, it is often not possible to know how radiation will impact your healing process after surgery on that breast. In general, using implants in a radiated breast is something I do not usually recommend. There can be up to a 40% risk of complications (infection, wound healing issues, capsular contracture) and ultimate "reconstructive failure" from an implant-based approach. There are often other options including rearranging the breast or adding healthy tissue to that radiated breast that are better options from a risk/benefit standpoint.  In addition, procedures for the opposite breast are available to improve breast symmetry. Your plastic surgeon should be able to help guide you in this decision-making process.

You really need to be seen in consultation with a plastic surgeon that does a lot of breast reconstruction.  There are many ways to reconstruct breasts and each technique has its place.  Generally radiation makes implants slightly higher risk for a variety of complications. But more importantly, implants ofter are not the first treatment choice after a lumpectomy.  I strongly suggest seeking the opinion of a surgeon that can examine you and discuss your care thoroughly.

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.