Breast Reconstruction After Radiation?

I have undergone the first stage of breast reconstruction after a double mastectomy. I will be getting the expanders removed in 2 weeks with implants replacing them. I am hoping for a full C. The doc said he will be putting 415 cc's. Is this a full C? I am 5'2" weigh 135lbs. Also, following the surgery I will have 5 weeks of radiation on the left breast. I would like to know everything I need to know to offer me the best results for the radiated side.

Doctor Answers 22

Radiation and Breast Reconstruction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You ask an excellent question. 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). Given your specific situation, you currently have tissue expanders. It is not wrong to proceed with your implant exchange prior to XRT. However, in my breast reconstruction practice, I generally will clear a patient with a temporary tissue expander to proceed with radiation therapy (XRT). Then I allow approximately six months to pass after XRT to allow for the radiation effects (inflammation/skin burn) to cool off. At this time, I recommend delayed definitive 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.

Radiation definitely complicated breast reconstruction. But in experienced hands, you definitely have options following radiation therapy.

I hope this helps.

Radiation and implant base breast reconstruction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
To reiterate my colleagues' answers, radiation therapy (XRT) has a deleterious effect on implant base breast reconstruction. It leads to capsular contracture, asymmetry, implant extrusion, infection, and pain from capsular contracture. On the other hand, XRT is very beneficial in the overall survival and recurrence rate for breast cancer and this is the most important factor in the overall treatment.

If a patient already has a tissue expander in and is about to have radiation, I would wait until the patient is finished with radiation prior to completing the final stage of the reconstruction. I would wait approximately 3 months after the radiation before embarking on the reconstruction. I prefer reconstruction with autologous tissue using the abdominal tissue (free TRAM or DIEP flaps). If a patient does not have abdominal tissue, I would reconstruct her breast using latissimus dorsi (back muscle) with implant.

I highly recommend that you seek a consultation with a board certified plastic surgeon who has extensive experience in breast reconstruction .

Mytien Goldberg, MD, FACS
Los Angeles Plastic Surgeon

Breast Reconstruction After Radiation?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello!  Thank you for your question.  Knowing that you will have radiation, it is a very reasonable decision to have the reconstruction that you had and still have excellent results.  While your expanders are in place, I would continue with creams and lotions to the radiated areas as well as massage of the area, in hopes of keeping the scarring to a minimum.  Afterwards, your plastic surgeon will continue with the 2nd stage of your reconstruction, at which time will likely remove as much scarring as possible to give you the best result.  Best wishes for a great outcome!

After radiation, you have a slightly increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap, if you have failure of your implant-based breast reconstruction.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Best wishes for a great outcome!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

415 cc breast implants should be about a C cup

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Given your size 415cc implants should end up with you being a C cup. This will depend a bit upon how thick your mastectomy flaps are. Also the fact that you will require radiation could effect your final result. Patients that get radiation have a higher incidence of capsular contracture or firmness around there implants. This sometimes can require further surgery to adjust the implant pocket.Your surgeon will be an excellent source of information in this regard.Good luck with your upcoming surgery,Dr T

Scott Tucker, MD
Winston Salem Plastic Surgeon
5.0 out of 5 stars 32 reviews

Radiation after Breast reconstruction with implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As previously explained by my colleagues, radiation has deleterious effects on the breast skin, and causes fibrosis which usually results in tightening of the skin. There are different approaches to the steps taken in breast reconstruction with implants in the setting of radiation. I prefer to leave the tissue expanders in place during the radiation process and exchange them for implants 6-8 months after the end of radiation. By this point much of the effects of radiation have taken place, and any specific adjustments can be made if warranted on the radiated side. 

Radiation after implant based breast reconstruction.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In the most current issue of Plastic and Reconstructive Surgery, a new study shows very high rate of implant based failure related to radiation.  There are some nuances of the article that I won't get into, but be prepared to deal with increased risk of implant loss, infection, capsular contracture.  Though each patient is different, make sure that your PS is well versed in managing issues related to radiation and implant based reconstruction.  Autologous (flap) recon, can be used to salvage a poor or failed outcome due to radiation.

Michael Orseck, MD
Greenville Plastic Surgeon
5.0 out of 5 stars 141 reviews

Breast reconstruction after radiation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A full C will be different depending on your body type and the bra manufacturer. Thus, it is impossible to know whether 415 cc will be a full C on you until the implants are placed in your body. With regard to implants and radiation, many surgeons believe that radiation is a relative contraindication to implant-based breast reconstruction. Radiation increases the chance of wound healing problems and infection, and since the implant is a foreign body without a blood supply it can make these problems worse. If you are going to undergo implant-based breast reconstruction and radiation, there is controversy over the timing of the breast implants. Many surgeons would radiate the tissue expander, and then wait at least 6 months before placing the permanent implant. The best aesthetic and medical results for the radiated side would involve undergoing autologous tissue breast reconstruction and avoiding implants altogether.

Radiation can affect the final result of breast reconstruction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. Firstly, cup size is a difficult thing to predict whether you are talking about breast reconstruction, breast reduction or breast augmentation. Every bra manufacturer sizes breasts differently. You make a C with one brand, but a B with another and a very full C with another - all those changes without surgery.

Radiotherapy cause fibrosis and scarring. The body forms a wall of scar tissue around all implants called a capsule. Sometimes this capsule can become thickened and distort the shape of the breast. This is called capsular contracture. On average, the degree of capsular contracture is worse on the side that has had radiotherapy. This can be a cause of asymmetry.

Radiotherapy can also cause wound healing problems and increases the risk of implant infection. It is good that you are having your radiotherapy after all your surgery has been completed. All the studies suggest that it is better to have radiotherapy to the final implant, rather than irradiating the expander.

I hope this helps.

Radiation after Mastectomy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question.   Breast reconstruction after radiation is a frequently debated topic.   The textbook answer is to utilize one's own tissue to permanently reconstruct a breast after radiation.

This is the philosophy that I employ in my practice, as i have seen first hand how much radiation can damage an implant reconstruction.

My preferred method of tissue reconstruction is a DIEP flap because the flap can be quickly harvested compared to the buttock or thigh tissue, and it allows for the benefits of a tummy tuck without loss of muscle function.

I would consult with a few board certified plastic surgeons with expertise in breast cancer reconstruction, prior to making your final decision.

I wish you a safe recovery.

Dr. GIll

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Breast recon after radiation.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Radiation will change the quality of the skin and increase you chances of capsular contracture. You will likely have some asymmetry but is can be fixed.

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.