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 36
Breast implant can be successful after lumpectomy and radiation
Breast preservation through lumpectomy and radiation treatment affords the best appearance and is far better than an effort to reconstruct after mastectomy. The effect of radiation will produce some shrinkage of the breast and produce some breast asymmetry. The radiation does not affect all patients equally and for some the breast can become quite stiff, or there may seem to be little effect as the breast will remain smooth and soft. We do have patients who seek implants to restore volume, and correct breast asymmetry after lumpectomy and radiation. I did a simple Google and was able to find information available to you, and you can also explore through your bookstore or local breast center. Generally after radiation there is a much higher rate of capsule contracture and firmness of the breast. We have had better success with form stable implants also called the 'gummy-bear' implant in reconstruction, or in the case of augmenting the breast which has been irradiated. With certain limits it can work, and each situation is unique. Though many surgeons may be less than enthusiastic you should take your time to read, consult ,and learn, as an implant could be an option.
Best of luck,
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 Reconstruction after Lumpectomy and Radiation
The use of skin expanders and breast implants for breast reconstruction after lumpectomy and radiation has a rather high complication rate. The skin may breakdown and the implants may become exposed or infected. Shrinkage of the radiated breast is common and can result in an unnatural-looking breast.
If your breasts are large enough a breast reduction of the opposite breast for size match of the side with a lumpectomy and radiation might be an option. If choosing this option, then you should allow time for full recovery from the lumpectomy and radiation so that the reduction of the other breast will be more accurate.
Flap breast reconstruction may be a good option at the same time as your lumpectomy using a latissimus dorsi skin and muscle flap without a breast implant depending on the size of your breasts.
While not for everyone, the use of TRAM flap or DIEP flap breast reconstruction can match most size breasts, and create a warm, soft, natural breast using your own skin and fat tissues.
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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.
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.
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.