Reconstruction after mastectomy and radiation

I had a right mastectomy in March of this year and was planning on having immediate reconstruction; however, one of the lymph nodes had a tiny bit of cancer in it so they did not do that.  I did have radiation and completed that in June, but did not require chemotherapy.  I am planning on having a TRAM flap and having my left breast reduced and lifted to match the right one (I wanted to be smaller).  Would it be reasonable for me to plan on having this done next March or April?  I have been very diligent about putting Aloe gel on my radiation site, am getting my strength back (even stopped working to speed my recovery) and am working out about 4 times a week (I'm 57).  I want to get this done and move on with my life.  I am VERY self-conscious about going out with the "one breast" and wear big shirts to camoflauge, and only wear the bra & prosthesis when line dancing as it is very uncomfortable. I would appreciate any help you could give me - thank you! Pam Murchison

Doctor Answers 10

Reconstruction after mastectomy and radiation?

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 26 reviews

Breast reconstruction after radiation

To answer your question directly, I typically wait 12 months after the completion of radiation to perform breast reconstruction. You had mastectomy in March 2011 but when did you finish radiation?

Discuss the timing of your restruction with your plastic surgeon.

When it comes to radiation, waiting the required amount of time, can make a big difference in getting a favorable result. I know you want to get it done and move on but you also don't want to get a substandard result either.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Breast Reconstruction After Radiation

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 that spares your abdominal wall muscle) 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.

Please visit our website to learn more about your autologous (tissue-only) breast reconstruction options.  I hope this helps.  Best of luck.

Dr. Basu

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

Delayed breast reconstruction after mastectomy and radiation

Adjuvant radiation after mastectomy is a vital part of our armentarium in adequately treating breast cancer.  Numerous studies have shown that in certain patient groups locoregional recurrence can be reduced and survival increased.  However, it has also been clearly shown that radiation has a detrimental effect on immediate breast reconstruction outcomes regardless of whether a tissue expander or flap are used.  Thus, most plastic surgeons prefer to perform delayed reconstruction in instances where radiation is indicated.  In regards to the timing of the breast reconstruction, there is some difference of opinion.  Most plastic surgeons feel comfortable with operating a minimum of 3-6 months after radiation treatment.  There are some who prefer to operate earlier (6-12 weeks) after the completion of treatment.  It's probably best to discuss the timing issues with your plasticesurgeon to better understand their rationale.  A TRAM flap breast reconstruction is an excellent option for most patients who have undergone post-operative radiation treatment.  

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon
4.8 out of 5 stars 45 reviews

Please get your reconstruction.

It sounds like you have been very diligent about your exercise and care to the radiation site.  I also must acknowledge how difficult it must have been for you without any form of breast mound while you underwent radiation.  By this point you should be more then ready for your reconstruction.  As long as the skin is healed and you desire reconstruction please do it.  I do think that using your own tissue after radiation is better then using an implant.  TRAM flap is one way.  I prefer a DIEP flap.  That is where we use the tummy fat but don't take the muscle.  Either way, you have been dealing with this for a year, it is almost over.

Kari L. Colen, MD
New York Plastic Surgeon
4.5 out of 5 stars 8 reviews

Radiation injury and breast reconstruction

I think the key to reconstruction after radiation is to evaluate the soft tissues. If they are soft and do not have any radiation inuury appearance than it is probably safe to pursue reconstruction. However, you have to be aware that the bllod supply to the irradiated field is still compromised and may impact the final result.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Optimizing reconstruction results after radiation

A quick check list that I recommend:

1. Moisturize skin 2x daily with Calandula Lotion

2. Build up to 50 sit-ups per day to increase blood flow to rectii.


4.Ask your surgeon about taking calcium channel blockers

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon
4.0 out of 5 stars 1 review

Breast reconstruction after radiation therapy

Once you have healed up from the radiation therapy, and are in good health, then you can have the breast reconstruction.  Most individuals are more than healed a year after their mastectomy and radiation treatment.  I would recommend going with either a TRAM flap reconstruction or other form of autologous tissue reconstruction such as Latissimus dorsi flap.  Both procedures give excellent results with very natural looking breasts.  By lifting and reducing the other breast you should be able to get excellent symetry and feel whole again.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 40 reviews

Reasonable plan

I have patients wait at least 6 months post radiation therapy before any surgery and I almost always include autologous tissue (tram or latissimus flaps).  Best wishes to you.

Mark D. Wigod, MD
Boise Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast reconstruction following mastectomy and radiation

For many women who require post-mastectomy radiation therapy, autogenous reconstruction is the preferred method.  There are several options from from where tissue can be moved from one part of the body to the breast.  The abdomen represents one of the most common "donor sites."  The TRAM flap (or transverse rectus abdominus flap) is an older method of breast reconstruction.  Technical advancements have allowed surgeons trained in microsurgical techniques to preserve the rectus muscle (one of the paired muscles of the abdominal wall).  This procedure is known as the DIEP flap (deep infeior epigastric artery perforator flap).  In this technique, the rectus abdominus muscle is spared, thereby reducing post-operative discomfort and reducing the risk of hernia formation.  This technique requires specialized training and is only offered at specialized centers, such as ours.

Loren Schechter, MD
Chicago Plastic Surgeon
2.0 out of 5 stars 2 reviews

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.