Breast Shrinkage 10 Years After Radiation for Breast Cancer?

Question

Hi there. My mom is a 10 year breast cancer survivor treated with lumpectomy and radiation. She has recently noticed the treated breast has shrunk in size. She had a normal CBE and diagnostic mammogram. Is this normal for the breast to shrink in size after so many years? What can be done?

Lewis Albert Andres, MD · Answer

Hello!  It is common for the breast to undergo shrinkage from the radiation.  Depending on the deformity and asymmetry - options include an implant, but more likely mobilizing tissue to reconstruct the lumpectomy defect or simply fat grafting.  Fat grafting has become a popular procedure to improve aesthetic outcome following breast reconstruction or for improvement of contour after lumpectomy.  Much of the newest research has investigated the properties of fat, in terms of its stem cell properties and associated advantages.	It has significantly ameliorated radiation damage by increasing vascularity.  Also, it adds additional "fatty tissue" atop the reconstructed breast mound to further contour any concavities or deformities, while also masking implant visibility with rippling and such.At our Breast Reconstruction Center, we have utilizing this technique almost routinely to maximize the aesthetic outcomes after lumpectomy or mastectomy.  We have utilized the micro-fat grafting technique, and have been obtaining maximal fat graft survival into the breast.  After harvesting of the fat from areas with excess fat, usually the belly, hips, or thighs, the fat is processed and injected back into the breast using the aforementioned techniques.  Our patients have been very happy with the results as well as the areas where the liposuction was performed.  Contour has been much improved using the micro-fat grafting technique, and the downtime is minimal.  Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.

Richard Baxter, MD · Answer

Radiation treatment for breast cancer causes permanent changes to the breast which limits the surgical options. Shrinkage after ten years is uncommon though. Sometimes the natural changes to the unaffected breast make them look more asymmetrical. Regardless, options are to reduce/lift the unaffected breast or do a muscle flap procedure to the radiated side. Implants in a radiated breast are more prone to problems such as capsular contracture.

Aldona J. Spiegel, MD · Answer

The effects of radiation are chronic and may go on for many years. This has to do with fibrosis of the tissue, leading to decreased blood supply which may atrophy or shrink over time. Weight changes can also affect the symmetry between the breasts, as the non radiated breast usually changes more with weight gain.

David Bogue, MD · Answer

The effects from breast radiation are permanent changes that can lead to progressive atrophy, fibrosis, and vascular compromise even years later. Contracture changes are common. It is often advised to perform operations on the contralateral breast to achieve a symmetrical appearance rather than to operate on the radiated breast. This is due to the significantly higher rates of complications that occur in radiated breasts. If one has to operate on the radiated breast, procedures which bring in healthy, non-radiated tissue (ie a Latissimus muscle flap) produce the best results. Fat transfer has shown some promise in improving contour deformities of radiated breasts as well. A consultation with a Plastic Surgeon with experience in breast reconstruction will allow you to understand what your mom's options may be.

Kamran Khoobehi, MD · Answer

The common outcome of the radiation treatment of the breast tissue is shrinkage and breast changes. The treatment options are limited to flap reconstruction. The use of implants is not recommended because of complications and unsatisfactory results.

Breast Shrinkage 10 Years After Radiation for Breast Cancer?

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