Risks of Breast Reconstruction with Implants After Radiation Therapy?
- Asked by Victoria1234 in Tampa, FL
- 4 years ago
I have recently had a bilateral mastecomy due to breast cancer in my left breast. I am currently undergoing chemotherapy and will be having radiation therapy. There is much conflicting information about whether breast reconstruction with implants is recommended or even feasible after radiation therapy.
I have had multiple surgeries previously, and I am concerned about having multiple surgical sites (such as those from TRAM or DIEP procedures). What are the risks of utilizing breast implants after radiation, and how long should one wait to have the implants to minimize risk (if possible to do so)?
Understanding Implant Risk after Radiation
Breast implants placed after radiation have a higher risk of infection. There is the potential for loss of the implant or scar tissue, capsular contracture, and pain. If possible, the preferred approach is to have tissue expanders placed at the time of mastectomy and prior to any radiation therapy. After radiation, if there are no implants or tissue expanders in place, the surgeon typically would wait 3 to 12 months prior to attempting implant surgery. The waiting period depends on the patient's skin characteristics and overall medical condition.
Implant Breast reconstruction following radiation
Although the risks are greater using implants following radiation, very good results can be obtained. Generally one should wait until the initial reaction to the radiation has subsided, but not so long that subsequent severe scar reaction has occurred. Results are also better if you had significant tissue and the skin was relatively loose after the mastectomy. Also, since you have had a bilateral mastectomy, your results will usually be better than someone with a unilateral mastectomy, since matching the two sides will be easier. The only way to really know exactly what your options are is to see an experienced Plastic Surgeon who can review these options at length with you.
Radiation treatment and breast implants
There are many reports that show that placing implants in a radiated bed leads to very poor results. The best treatment is to provide autologous tissue to reconstruct this region.
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Implant breast reconstruction after radiation
There is a very high, some say almost 100%, risk of capsular contracture with an implant reconstruction after radiation therapy. It is not that you can't give it a try, but at the first sign of the tissues not expanding, I would quit with this mode. Pushing farther will only lead to problems. I have taken care of far to many patients who have come to me after multiple attempts at this, all of which were either failures or where the results were so hard that they were worse than not doing it. Make sure you go to a plastic surgeon who specializes in breast reconstruction and can do all different types including free flaps so your best options can be determined.
Web reference: http://www.randcosmeticsugery.com
Implant Reconstruction and Radiation
There is some controvery on how to approach breast reconstruction when radiation therapy (XRT) is required. Radiation therapy is excellent in helping you reduce your risk for recurrence. This is the most important thing. As I tell my patients, radiation is excellent at killing microscopic cancer cells. However, radiation does "fry" the non cancer normal tissue as well. Radiated tissue will never be the same.
Although some notable studies have shown acceptable results with implant-based reconstruction in patients who required XRT, I tend to subscribe to the perspective that implants and radiation don't mix well in the long run. Why? Because we know that radiation therapy significantly increase the risks for capsular contracture (a vigorous scar tissue response). It is not wrong to proceed with tissue expander implant reconstruction after radiation. However, I generally do not recommend this in my practice becasue radiated tissue is very diffcult to stretch out. There is an increased risk of complications in delayed implant reconstruction following XRT.
In my breast reconstruction practice, following XRT, I recommend delayed autologous (tissue) reconstruction with excess abdominal tissue (DIEP flap) or back tissue (latissimus flap). The reason why I recommend autoloogus reconstruction following radiation is that the new tissue that is brought to the radiated site, I believe, brings new non-radiated soft tissue, new blood supply, and perhaps new healing potential to a radiated chest wall. Furthermore, a tissue-only reconstruction (DIEP flap) may not require a foreign body implant. Hence this eliminates any risk for foreign body (implant) scar tissue (post radiation capsular contracture). I believe a tissue-only reconstruction breast following radiation therapy will give my patient the best long lasting result.
You are correct. Tissue reconstruction is more involved surgery and requires an incision. Although implant (tissue expander) reconstruction may not require surgery on another part of your body, I believe following radiation, I would not recommend implant based reconstruction on the radiated side for my aforementioned reasons.
Radiation definitely complicated breast reconstruction. But in experienced hands, you definitely have options following radiation therapy.
Please visit: www.breastreconstructionhouston.com to learn more about your options. Our concierge service at the Institute of Advanced Breast Reconstruction is experienced in helping out of town patients meet their goals for breast restoration.
Web reference: http://www.breastreconstructionhouston.com
Breast implants reconstruction after radiation
The use of breast implants in breast reconstruction after radiation has a high rate of wound complications(delayed healing, implant exposure) and capsular contracture. If an implant is anticipated you would probably go with an expander first, going through very slow expansion.
Another option would be a latissimus dorsi flap with an expander or implant.
Radiation therapy and implant reconstruction.
There is no doubt that there are increased risks of complications with implants following radiation therapy. This does not mean that it should not be done but that you should be aware of this. Clearly you have an understanding as is indicated by your mention of the autologous tissue flaps which are generally preferred with a history of radiation. There are conflicting reports about the timing, some studies suggest within 6 weeks while others advise waiting 3-4 months. In any situation, you should wait until infalmmatory changes to the skinhave subsided.
Post-mastectomy radiation therapy and breast reconstruction
Although a beneficial adjunct for breast cancer in several circumstances, radiation therapy (RT) has also detriments to both the patient as well as plastic surgeon in breast reconstruction. Above all, treatment for cancer comes before the aesthetics of breast reconstruction, and the proven benefit outweighs the ill-effects of RT. The impact that RT has on the skin, as evidenced by the radiation dermatitis/radiation burn, angiofibrosis, contrcture/fibrosis of the skin, and soft tissue, as well as the healing/infection issues are not favorable.
From the plastic surgery standpoint, these effects are troublesome, especially when dealing with reconstruction. This should be discussed with your plastic surgeon, as it impacts the type of reconstruction you should have. Women undergoing lumpectomy are often told that most of their breast will be preserved and that radiation will be needed postoperatively. However, what is not conveyed, is that the above changes may occur and account for some of the breast asymmetry or contractures. Although a "breast conserving" therapy is performed, many women end up seeking a plastic surgeon to assist with these issues, which often times, include the same procedures as if a mastectomy was performed anyhow.
Implant-based reconstruction is not a recommended reconstructive procedure following RT. The complication rates are markedly increased with often times, poor aesthetic results, let alone the wound healing, infection, and capsular contracture/asymmetry rates, among others. This type of reconstruction usually fairs poorly following RT. There are several studies showing good results following implant-based reconstruction, however. Many times, RT is not known until final pathology returns several days later.
Radiation after flap-based procedures are significantly better following RT. After a flap procedure (e.g., latissismus, TRAM, or DIEP flap, recruiting well-vascularized tissue from a remote area negates some of the ill-effects that RT has done. There still is a chance for the reconstructed breast to shrink or contract if followed by radiation, but it resists the effects much better than implants. Usually, performing this in a delayed fashion would allow your plastic surgeon to excise all of the affected tissue, and use the flap to reconstruct the defect. This is my preference after, or for known RT. The flap-based reconstructions (e.g., latissimus, TRAM, or notably the DIEP), are excellent options as discussed in previous posts.
Web reference: http://www.albertandresmd.com
Possible, but best to consult with both your oncologist and reconstructive surgeon
Breast reconstruction is not a one-size-fits-all procedure. The timing and technique best for your specific breast reconstruction case will be highly influenced by the amount of healthy, natural breast tissue you have after your mastectomy as well as the elasticity of your skin.
Because you also mention previous surgeries, the presence of existing scar tissue may also influence your procedure. It is possible to undergo breast reconstruction with implants after chemo and radiation; however, it is usually necessary to use a tissue expander to stretch the skin in order to make an adequately sized envelope for your implants. It’s best to speak with your oncologist and prospective reconstructive surgeon in person so that they can assess how you are healing and give you more customized advice as to the timing and type of reconstruction that would be best.
Implants for Reconstruction After Radiation
When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation therapy can mean a significant loss of skin elasticity, which can profoundly affect the aesthetic results of breast reconstruction. And because the body’s wound-healing mechanisms are altered by exposure to radiation, complications from all types of reconstructive breast surgery occur at a higher rate.
Even in the absence of radiation, the re-operation rate for women who undergo breast reconstruction with breast implants is about 50% within 5 years of surgery (according to the FDA). Complications of implant reconstruction including capsular contracture, implant exposure/extrusion, unsatisfactory cosmetic appearance, infection and pain all occur at a higher rate if radiation is part of a woman's treatment plan.
Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process.
Because of the potential complications associated with implants, breast reconstruction using natural tissue is generally considered the best and most reliable method of reconstruction for women who will require or have already had radiation. While you may be reluctant to accept another surgical site for a procedure such as a DIEP flap reconstruction, I would encourage you to get a firm handle on all of the risks and benefits of the implants and natural tissue reconstruction before deciding on which, if any, method of reconstruction is best for you.
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.