Both of my breast had radiation due to breast cancer. Is It Good to Have Reconstruction Breast Surgery After Radiation Therapy?

Both of my breast had radiation thearpy due to breast cancer. I'm going to have a biliteral mastectomy with immediate breast reconstruction (DIEP) with skin sparing. Is  this a good thing to do with radiated skin? I had my !st radiation in  April of 2001 right breast, and the left breast in March 2011. I suffer with Lymphedema in both arms due to lymph nodes removal, and how will that affect the breast reconstriction and me afterwards? Will the swelling in my arms get worse? Please help!!! 3rd time breast cancer survivor. Thank you very much, Ms. shon don  

Doctor Answers 8

Is it good to have reconstructive breast surgery after 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!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Yes you can have DIEP flaps after radiation therapy

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By undergoing completion mastectomies and radiation therapy our ususal recommendation would be to use your own tissue in the form of DIEP flaps.  The flaps usually fair extremely well.  the radiated skin and fat that remain from each breast are referred to as the mastectomy flaps.  It is these areas where I have seen the issues that develop.  Typically these are small areas that take longer to heal.

Breast reconstrution following radiation

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Breast reconstruction may be performed following radiation.  Typically, we perform flap reconstruction (ie diep flap) in this setting.

Loren Schechter, MD
Chicago Plastic Surgeon

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Use your own tissue for breast reconstruction after radiation - DIEP

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It is great that you are a survivor and can be considered for reconstruction.  Your previous radiation therapy is a risk factor for reconstruction but it doesn't mean that you can't have reconstruction.  It does mean that implant based reconstruction is probably not a good option without the use of bringing in some of your own healthy tissue from your tummy or your back.  The DIEP may very well be the best option for you and is reliable in experience hands.  Make sure that you see a board certified surgeon that has been doing this for awhile and is comfortable performing the procedure.  I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Breast reconstruction after radiation

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I am grateful that you are a 3 time breast cancer survivor.  I am sure your doctors want to give you all the quality of life they can as well and have offerred the reconstruction for that purpose.  For this reason, though, the last thing you need is a complication after breast reconstruction.  I have done a substantial amount of reconstruction and without examining you, these are just general comments, but you are in no way a "good" candidate for reconstruction.  Skin sparing mastectomies in the face of radiation have a higher risk of skin death and bilateral DIEP flaps are very extensive and complex operations with a potential for flap loss.  So, while it isn't as if it can't be done, please make sure that your doctors are up front about these risks and aren't minimizing them or that you just aren't hearing them.

Is It Good to Have Reconstrution Breast Surgery After Radiation Therapy?

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I believe your question s are very hard to explain via the internet. You should discuss these issues in person with the radiation doc, your PS, your oncologist, and GS. There are increased risks in radiated tissue and lymphedema in arms that you need to fully understand. Best of luck. 

Breast Reconstruction after Radiation

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The most important consideration in your case is complete removal of the cancer. You do not have to have a breast reconstruction if you are either reluctant or feel you are being pushed into it. 

Breast Reconstruction ia a complex topic and volumes have been written on it. In general, the reconstructive surgery should be delayed after the radiatin was completed to prevent major complications. A DIEP flap is a very elegant way to reconstruct the breast especially in a setting of previous radiatin because the radiated breasts are replaced by new, unradiated skin. It will not improve your lymphedema but depending on how the DIEP flap's blood vessels are connected it may not worsen it either. all these questions are valid and are best answered by your surgeon. Do not hesitate asking questions. Your surgeon likes you to be informed and be a partner in your surgery. 

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast reconstruction after radiation treatments

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Your question about options for breast reconstruction after radiation treatments for breast cancer is a good one. Breast reconstruction after radiation can be done, and I believe the best option is to have fat grafting for reconstruction. The fat grafts can help to reverse the radiation damage. This is probably because fat grafts have many stem cells in them.

Scott C. Young, MD
Medford Plastic Surgeon

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.