Breast Implants After Lumpectomy and Radiation?

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.

Doctor Answers (33)

Breast implants generally not recommended for irradiated breasts

+2

Generally, implants are not recommended in an irradiated breast. The rate of complications and contracture is much higher. It does not mean that it can never be done, but you must be informed of the risks and alternatives.

In some cases, there may be better options, such as a local tissue rearrangement or the use of autogenous tissue.

Best to discuss all of these with your plastic surgeon.


Atlanta Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast implants and radiation

+2

 In general, breast implants and radiation don't mix.  The risk of capsular contracture in this setting is so high as to be almost a certainty.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

Breast reconstruction with implants following breast cancer reconstruction

+2

Here is a layman and succint explanation of the issues:

http://breastreconstruction.org/ReconstructionOverview/RadiationandReconstruction.html

However, in summary, there are an increased risk of complications. Generally most surgeons prefer to use your own vascularized tissues .

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

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Implants after Lumpectomy and Radiation

+1
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.

Kendall Roehl, MD
Houston Plastic Surgeon
5.0 out of 5 stars 3 reviews

Implants after lumpectomy and radiation

+1
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.

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 10 reviews

Breast implants and radiation can be a difficult combination!

+1
I am very selective in the use of implants after radiation therapy.  The tissues are no longer the same.Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!

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+


Robert Whitfield, MD, FACS
Austin Plastic Surgeon
5.0 out of 5 stars 13 reviews

Implants after lumpectomy with radiation

+1

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. 


Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 35 reviews

Increased complication rate for breast augmentation following radiotherapy

+1

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.

Damian Marucci, MBBS, FRACS
Australia Plastic Surgeon
5.0 out of 5 stars 3 reviews

Breast Implants After Lumpectomy and Radiation

+1

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.

Mark A. Schusterman, MD
Houston Plastic Surgeon
5.0 out of 5 stars 63 reviews

Implants following lumpectomy and radiation

+1

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.  

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

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.