Delaying Breast Reconstuction for Radiation Therapy?

Why is it best to delay Breast reconstruction if radiation therapy is required?

Doctor Answers 5

Individualize reconstruction: Delay often, but not always, the best

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Radiation therapy is done for control of "local" disease. The goal is to decrease the chance of recurrence in the area of the old breast tissue. If your oncologists recommend this, we want you to have the best care. Radiation therapy does negatively effect the breast reconstruction, regardless of the methods used. It causes more scaring and contraction of the remaining skin and subcutaneous fat. It reduces blood vessel growth and healing.

If all other considerations are equal, using your own tissue, with its own blood supply can give you less chance of radiation problems (pedicle or microsurgical free TRAM flaps). There are advantages and disadvantages to immediate or delayed reconstruction.

My choice is typically to choose delayed reconstruction if radiation therapy is planned. Your surgeon may make another recommendation, and he or she has the advantage of knowing more about you and your circumstances.

Greenville Plastic Surgeon

Delayed breast reconstruction not always best

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Radiation for breast cancer treatment changes and complicates reconstruction because of the reaction and scarring it can cause and the increased complications with implants or flaps. However, philosophies are not uniform and some surgeons advocate immediate reconstruction even in the face of radiation. Flap reconstruction certainly is tolerated better than implants but placement of expanders or implants, despite potential complications, may allow preservation of valuable soft tissue that is discarded with delayed reconstruction. The path of breast reconstruction should be individualized with each patient.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Delaying breast reconstruction for radiation therapy?

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Hello!  Thank you for your question.   After radiation, you have an 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.  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.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  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.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

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

Radiation and reconstruction

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Radiation can cause damage to the surrounding tissue and make an impalnt very hard. That is why it is best to delay the reconstruction.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Yes, delay the breast reconstruction

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The best answer to this question is to delay the reconstruction. There are some surgeons that will tell you that you can use your own tissue for immediate reconstruction then proceed with radiation treatments and that is not wrong but the quality of the reconstruction is affected just like with implant reconstruction. Radiation therapy is great in the treatment of cancer but it also affects normal tissue therefore if you have an immediate reconstruction using your own tissue the radiation can cause internal scarring of the tissue used for your reconstruction. This situation is even worse when an implant reconstruction is carried out prior to radiation treatment. In my opinion it is wise to delay any type of reconstruction when radiation treatment will be a part of your cancer therapy.

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.