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.  

Every woman will have different issues and concerns, of course, following a lumpectomy and radiation. However, in some cases, it is possible to use breast implants after lumpectomy and radiation. Depending on the individual patient, either saline or silicone gel implants can be used. The good news: implants may be used to help correct asymmetries caused by the lumpectomy. A potential disadvantage: for some patients, tomography mammography can be more difficult after implants. In contrast, MRIs and sonography procedures are not affected by breast implants.Breast Implants Following Lumpectomy and Radiation

The advantage of lumpectomy and radiation therapy is to preserve the breast shape and symmetry. If the lumpectomy or partial mastectomy  causes significant deformity of the breast or significant asymmetry. Then one would have  been better off to undergo a mastectomy and Reconstruction and possibly not need radiation. If there is significant breast deformity my first recommendation is to do a completion mastectomy, possibly saving the nipple and areola and immediate  autologous reconstruction. If the patient is unwilling to do this, the partial defects of the breast can be filled with local flaps or latissimus dorsi muscle flap. The implants are not generally successful  after radiation and can make the detection of a recurrence more difficult.

The truth is that breast implants are used after radiation in patients and many patients do well.  What we see as experts in breast reconstruction is a bias towards those patients who have failed breast implants in the setting of radiation, requiring redo reconstruction.  It is radiation dose dependent and no one can make summary opinions on this matter.

Breast Implants can be placed after radiation and lumpectomy treatment for breast cancer. However, the rate of complications is significantly higher. You should consult with a board certified plastic surgeons who can evaluate your particular needs and goals. Often there maybe other options including soft-tissue rearrangement or autologous flaps.

Wow...Healer, you have recieved some fantastic advice here, isn't www.realself.com a great outlet and resource for you! (FYI, I do not work for them, but think this is a great site).
I generally do not recommend breats implant after breast irradiation. The plastic surgery literature documents a higher rate of complications and I have seen a number of patients in my office from other surgeons who have received implants in the irradiated breast. However, not all 2 patients are alike and every patient comes with individual needs, wants, goals and expectations. We as scientific, evidence based surgeons use the peer-reviewed literature as practice guides for standardizing care. I would recommend you see a Board Certified Plastic and Reconstructive surgeon (www.plasticsurgery.org) who can evaluate your individual case and make appropriate recommendations!
Good luck!
Dr. C