Is It Safe To Put Implants In After Radiation?

Question

I was diagnosed with breast cancer in May 2010 at the age of 33. I since have undergone a bi-lateral mastectomy...chemo and radiation. I am scheduled to begin reconstruction in Sept 2011. Due to the radiation on my right side would it be safer to do a DIEP procedure which is what my surgeon wants to do or can I just go with implants which is what I would like to do? Ive been checking up on it and have found alot of sights which say not to put implants in radiated skin

Lewis Albert Andres, MD · Answer

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!

Frank Agullo, MD · Answer

The use of implants after mastectomy with radiation for reconstruction has an increased risk of complications. The most common complications are wound healing problems, capsular contracture, and infection. It is always a better option to use your own tissue for reconstruction after having radiation. Options include a TRAM, DIEP, or latissimus dorsi flap. You should be comfortable with your plastic surgeon and he should take the time to explain the options and pros and cons of each procedure.

Kamran Khoobehi, MD · Answer

The problem with the implant post mastectomy and radiation is the capsular contracture. You can get bilateral DIEP breast reconstruction if your plastic surgeon feel comfortable doing that.

Adam Hamawy, MD · Answer

Breast implants after radiation are associated with a very high chance of complications including implant exposure, capsular contracture and infections.  This is because the radiated skin and tissue on the chest wall has less pliability and a poorer blood supply.  For these reasons a flap reconstruction using your own tissues is strongly recommended in these situations.  This can be using your abdominal tissues such as a DIEP or using one of several other options that can be discussed with your plastic surgeon.  

	If you do decide to proceed with the breast implants be prepared for the possibility of implant removal if a complication develops.  You can always still keep the flap as a backup plan.

Chen Lee, MD · Answer

So sorry for what you are going through. Radiated tissue generally reduces the quality of the soft tissues and increases the complication rate of implant reconstruction. An experienced surgeon in microsurgery and DIEP flap is recommended. There are substantial risks with DIEP's. However, preserving the abdominal muscularity in patients with bilateral breasts to reconstruct is worthwhile to reduce the risk with abdominal wall weakness. Wishing you the best of outcomes.

Peter A. Aldea, MD · Answer

RE: " I was diagnosed with breast cancer in May 2010 at the age of 33. I since have undergone a bi-lateral mastectomy...chemo and radiation. I am scheduled to begin reconstruction in Sept 2011. Due to the radiation on my right side would it be safer to do a DIEP procedure which is what my surgeon wants to do or can I just go with implants which is what I would like to do? Ive been checking up on it and have found alot of sights which say not to put implants in radiated skin"

	II'm sorry for your condition.  Radiation permanently scars the skin, makes it hard and less elastic and reduces the blood flow in the skin. This makes the skin less likely to expand without difficulty and is often associated with a high rate of complication ranging from implant exposure to capsular contracture. If your surgeon thinks you are a good candidate for a DIEP reconstruction and he does a fair number of them, that would probably be a better option.

	Dr.Peter A Aldea

Brian Klink, MD · Answer

As a general rule, plastic surgeons do not want to place expanders and implants in tissue that has been irradiated. The complication rate is much higher and can include poor tissue stretch (the implants won't be large enough), increased scar tissue formation (capsular contracture) and the expander and implant can come through the skin (extrusion). The basic cause is firm tissue that does not have normal pliabilty due to the radiation. Bringing in better, undamaged tissue (like your surgeon is planning) is the best option. I hope it goes well!

Ricardo Izquierdo, MD (retired) · Answer

Most plastic surgeons agree that using implants after radiation for breast cancer increases the risks of complications including infection, capsular contracture, and implant exposure.  Radiated tissue has become more internally scarred, thinner, and  with a decreased blood flow.  Your surgeon has given you good advice to consider the DIEP flap for reconstruction.

John Whitt, MD (retired) · Answer

Breast reconstruction with implants alone or an tissue expander followed by implants definitely has increased risks especially related to wound healing. Better options are a TRAM or DIEP or a latissimus flap with or without an implant as each of these procedures brings healthier unradiated tissue into chest area.

Richard P. Rand, MD, FACS (retired) · Answer

If you have enough tissue for a flap reconstruction it will be much better than an impolant because the risk of capsular contracture around an implant in an irradiated bed is virtually 100% in some series. So sorry you have had this unfortuante occurrence .

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