Can I Have Immediate Reconstruction if I Need Radiaton Afterward?
Doctor Answers 13
Breast Reconstruction with Radiation
Radiation injury to the chest wall can take up to 6 months to settle post-treatment. I always recommend delaying the final tissue reconstruction until this time. At this point, the skin and tissue damaged by radiation can be safely removed and healthy nonradiated skin and soft tissue transferred in to reconstruct the breast.
During the mastectomy, some surgeons may elect to offer delayed immediate reconstruction by placing a tissue expander to maintain the skin envelope during adjuvant therapy and provide a temporary breast mound. This is dependent on the recommendation of your radiation oncologist, cancer surgeon, and reconstructive surgeon.
I typically find patients have less pain and discomfort by not placing the tissue expander immediately and delaying final tissue reconstruction until 6 months post-radiation. However, there is the psychological downside of not having a breast mound for 8-12 months.
I wish you a safe and healthy recovery.
Paul S. Gill, M.D.
Gill Plastic Surgery
Houston Double Board Certified Plastic Surgeon
Delaying breast reconstruction until after radiation is usually the safest approach
Radiation therapy can result in a significant loss of skin elasticity, and because the body’s wound-healing mechanisms are altered by exposure to radiation, complications from all types of reconstructive breast surgery occur at a higher rate. While radiation therapy can complicate breast reconstruction surgery, with proper preparation most women can achieve a satisfactory reconstruction even if radiation therapy is part of their treatment plan.
Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process. For these reasons, many plastic surgeons will not perform implant reconstructions for women who have been treated with radiation.
Delaying reconstruction until 6 months or ore after the completion of radiation therapy will allow your surgeon to replace radiation-damaged skin with soft and supple skin that has not been exposed to any radiation. Doing so allows for the shaping of a more natural-appearing breast and also reduces the chance of complications.
Breast reconstruction and radiation
If you know you are going to have radiation for sure, I would recommend delayed reconstruction. If you were not sure, then having reconstruction is OK. Nowadays, tissue expanders can be placed in the latter situation. Expansion can be completed with implant placement or the expander can be removed and replaced with your own tissue if you do not have radiation. If you were to end up needing radiation, the field can be radiated then the expander can be removed and replaced with your own tissue.
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Breast Reconstruction and Radiation
Although never a good combination there are certainly times when it is appropriate. I have found that when approached as a team treament plan this can work well in the right patient. In my practice I have found that just the fact that a reconstructive procedure has started gives the patient a significant psychological boost. The caveat is that it doesn't interfere with treatment. Cure comes first then we can treat the reconstruction with any variety of techniques.
Can I have immediate reconstruction if I need radiation afterwards?
If you do have complications 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!
Yes you can have radiation if you have immediate Breast Reconstruction!
This practice is common now unless the tumor characteristics are concerning such as being very close to the chest walll which would make it hard to detect a recurrence when you doctors examine you. Fortunately this is very rare so that the majority of patioents can have an immediate breast reconstruction and move forward with chemotherapy and radiation therapy.
Breast reconstruction is a group effort and coordination, The general surgeon, The Radiation Oncologist, The oncologist and Family physician.
Communication between all these specialtie caqn draw a plan and best method and timing of the breast reconstruction.
What type of mastectom? Skin sparing? And how to preserve the skin sparing and what are the effects of the radiation and how to minimize the skin of the breast from scarringdown.
May be the insertion of a temporary tissue expander will preserve the skin and cavity for future FLAP reconstruction.
Does that delay the timing of the radiation and what side effects are there(OPINION OF THE RADIATUIN SPECILIST, AND ONCOLOGIST)
Coordination with the Oncologist, is chemtherapy needed and what type?
The opinion of the General surgeon, and how he/she does the mastectomy, how thin of skin flaps he/she does the mastectomy?
All these issues has to be COORDINATED and PLANNED and REPLANNED.
In my practice I even go to the operating room with the general surgeon at the time of mastectomy to SEE what was done , and What I should expect in the future.
I need to think of somthing to protect the skin for the future reconstruction.
BREAST RECONSTRUCTION PLANNING IS A TEAM EFFORT.
All this is done with you in the picture and fully informed of every thing
Immediate breast reconstruction before radiation??
Yes, you can have an immediate reconstruction even if you know you'll have radiation treatments. But your best cosmetic result would come if you have the radiation first, then have the reconstruction, in most cases. If you do choose reconstruction prior to radiation, I would try to avoid using an implant (you can add one later if you need it), and I would use autologous tissue for your reconstruction (TRAM). However, a TRAM flap can certainly become damaged with radiation, and then you wouldn't have another abdominal option for reconstruction--you'd have to use tissue from your back (lat dorsi), most likely.
This is not a simple question, and it's definitely one you should carefully consider with your general surgeon and your plastic surgeon. Best wishes!
Reconstruction and Radiation
There is some controvery on how to approach breast reconstruction when radiation therapy (XRT) is required. Radiation therapy(XRT) is excellent in helping you reduce your risk for recurrence. This is the most important thing - your cancer treatment plan. 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. And XRT will complicate your reconstructive process and may add some steps to the whole process.
The traditional answer is if you need radiation, you should wait until after your cancer treatment to proceed with reconstruction. However, there are more options available for immediate reconstruction in your situation. Ask your plastic surgeon if he/she offers delayed-immediate reconstructive options.
Radiation definitely complicates breast reconstruction (by adding steps to the process). But in experienced hands, you definitely have options following radiation therapy.