Options for Breast Reconstruction for Those Who Had Radiation?

What breast reconstruction options are best suited for radiation patients. complications? Is back tissue a good option to consider? Why?

Doctor Answers 10

Options for Breast Reconstruction for those who had Radiation?

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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. 

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

Breast Reconstruction After Radiation

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Breast reconstruction after radiation is a bit controversial. Options mostly depend on the quality of tissue after radiation. If the tissue is soft and stretchable, implant based reconstruction can be very successful. If the tissue is tight, thinned, or scarred, tissue based reconstruction, such as latissimus flap with an expander, TRAM flap, or DIEP flap is more appropriate.

Karen Vaniver, MD
Kennewick Plastic Surgeon
5.0 out of 5 stars 38 reviews

Breast reconstruction after radiation

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I prefer to use your own tissue after radiation.

Three basic forms of breast reconstruction exist. You can use your own tissue, implants or a combination of the previous two techniques. Your own tissue can be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting. Implants can be done in one stage or two stage. Two stage reconstructions are started by placing expanders at the time of mastectomy. Once they expanders are placed they are able to be inflated as determined by wound healing. The final time consists of combining any of the above techniques.

If you are interested in being seen in Austin please give us a call. I know this is a difficult time for you. The majority of my practice is devoted to reconstruction for women with breast cancer or who are BRCA+

Breast Reconstruction After Radiation

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I always recommend transfer of non- irradiated tissue for reconstruction after radiation.  The back tissue may be one option depending on the situation, but I prefer the lower abdominal tissue.  

Breast Reconstruction After Radiation Therapy

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Breast reconstruction for patients who are going to have or who have had radiation therapy is best accomplished with flap breast reconstruction techniques that utilize only your own skin, fat, and muscle tissues.  

These all natural tissue breast reconstructions eliminate the potential complications of breast implant infection, breast implant capsule contractures, breast implant exposure.

While not for everyone, flap breast reconstructions such as TRAM flaps, or DIEP flaps offer reconstructions with tissues that have their own circulation that is resistant to infection, is healthy tissue that brings additional blood supply to the breast reconstruction area.

Fredrick A. Valauri, MD
New York Plastic Surgeon

Post Radiation Breast Reconstruction Options

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There is some controvery on how to approach breast reconstruction after radiation therapy (XRT). Radiation therapy is excellent in helping you reduce your risk for recurrence.  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).  In my breast reconstruction practice, I generally recommend some form of autologous (using your own tissue) reconstruction after XRT. - such as  DIEP, SIEA, or TRAM 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 (such as the 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.  Best of luck.
Dr. Basu

Breast Reconstruction after Radiation

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Due to the high incidence of capsular contracture with breast implants in those who have undergone radiation, I do not recommend their use in these patients.   Although the latissimus dorsi  (LD) flap involves a quicker recovery than other traditional tissue flaps, it often requires a small implant to provide projection and an aesthetically pleasing breast mound.   Therefore in radiated patients, I prefer the LD flap as a backup procedure in the event that a patient is not a candidate for tissue only reconstruction.

Our preferred method of tissue only reconstruction in the radiated patient is a DIEP flap.   The abdominal skin and soft tissue is very close in consistency to natural breast tissue and can be shaped to restore much of the normal anatomic boundaries of the breast.     Secondly, the abdominal skin is used to replace the radiated chest wall skin, providing a smooth soft natural appearing breast mound.

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

Your best option is autologous breast reconstruction.

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Patient with radiation have higher risk of capsular contracture. Using DIEP flap from the abdomen without the use of the abdominal muscle is a good option if you have fatty tissue over the lower abdomen.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Breast reconstruction

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Radiated tissue does not do well with implants. Implant failure is very high in radiated tissue.

The back muscle and skin (Latismus Dorsi Myocutaneous flap) will bring with it a health muscle with good blood supply and can use an implant undr that muscle.

Othe option is the excess skin and fat in the lower abdomen, TRAM Flap, if there is enough fat you will not need an implant.

Other options are the Free Flaps, taken from the abdomen, or the buttocks

Samir Shureih, MD
Baltimore Plastic Surgeon

Breast reconstruction after radiation

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If you have some extra tissue in the lower abdomen, this is the best option for breast reconstruction (TRAM, DIEP flaps) after radiation because it can be shaped into a soft natural looking breast.  The radiation makes it extremely difficult for implants to work without dense scar tissues forming around them.  Please go to a plastic surgeon who can offer you ALL options including microsurgical flaps (TRAM, DIEP etc) so the best option can be selected for you.  The back (latissimus dorsi flap) is another non-radiated source of tissue but usually requires an implant.

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.