The Effect of Radiation on Breast Reconstruction: What you need to Know
Due to advances in medical technology, radiation therapy is one of the most common treatments for breast cancer patients. However, this treatment can also have long-term effects on breast reconstruction surgery and its outcomes. This article will discuss the effects of radiation on breast reconstruction and provide information on the timing of reconstruction before or after radiation therapy.
What is radiation therapy?
Radiation therapy is a type of cancer treatment that uses high-energy beams, such as X-rays or protons, to destroy cancer cells. It can be used alone or in combination with chemotherapy, surgery, and other treatments. Radiation therapy is often recommended for those who have been diagnosed with breast cancer because it can reduce the likelihood of breast cancer coming back after treatment.
Who needs radiation therapy after breast cancer surgery?
When it comes to breast cancer treatment, radiation therapy is often a key part of the plan. This therapy is often recommended for patients who have undergone a lumpectomy, breast-conserving surgery, or sometimes after mastectomy. It is also used in combination with other treatments, including chemotherapy and hormone therapy.
Radiation therapy works by killing breast cancer cells that may remain after surgery. By reducing the risk of breast cancer recurrence, radiation can be an important part of treatment even after the initial surgery.
The recommendation for radiation is usually by consensus between your breast surgeon (surgical oncology), medical oncologist, radiation oncologist and plastic surgeon. This decision is often informed by your breast cancer stage, tumor characteristics and personal risk factors.
What to expect after breast external beam radiation?
After undergoing radiation therapy, your skin may feel dry, itchy, and irritated. This is normal and will improve over time. You may also experience a feeling of tightness around the chest area due to the radiation affecting your soft tissue. Additionally, you may have some scarring at the site of the radiation treatment due to damage from the radiation beam.
Radiation therapy can cause long-term changes to the skin in the area of treatment. This includes scarring, discoloration, and damage to underlying tissues that can affect how your breast looks and feels. In some women, these effects can be quite severe. As a result, it is important to consult with a plastic surgeon before undergoing radiation therapy to discuss the impact of these potential changes, particularly when undergoing breast reconstruction.
Effects of radiation on breast reconstruction
Studies show that radiation therapy can have a significant impact on reconstructive outcomes. The radiation itself can affect the skin, making it more difficult for plastic surgeons to create an aesthetically pleasing result. This is especially true when radiation is performed shortly before the reconstruction. In cases of bilateral reconstructive surgery, it can be particularly difficult to match the radiated side to the other breast.
The intensity of the radiation and its duration can also affect the outcome of breast reconstruction. For example, if radiation is given in a smaller area over a shorter period, it may cause less damage to the surrounding tissue. However, if radiation is delivered in a wider area or for a longer period, it can lead to more severe changes in the chest wall that can make breast reconstruction more difficult.
What surgical complications are impacted by radiation?
In addition to changes to the skin, radiation can also cause several types of surgical complications. This includes delayed healing, an increased risk of infection, scar tissue, and a higher risk of wound dehiscence (when a wound opens up after surgery). Additionally, chest wall radiation can make it more difficult for surgeons to properly place implants during breast reconstruction. All these factors together make implant reconstruction surgery more prone to failure.
Risk of lymphedema with radiation
In some cases, radiation can also increase the risk of developing lymphedema. Lymphedema is a condition where extra fluid accumulates in the arms and legs due to damage or changes to the lymphatic system. This can lead to swelling, pain, and skin discoloration in the affected area. In the case of breast cancer surgery, particularly when an axillary lymph node dissection is performed, the risk of lymphedema in the arm increases significantly.
Timing of breast reconstruction
The best way to minimize the effect of radiation on breast reconstruction is to plan the timing of reconstruction carefully. In many cases, it is recommended that patients wait at least six months after radiation therapy before undergoing reconstructive surgery, as this will allow enough time for the effects of radiation to diminish.
However, in some cases, surgeons may recommend performing immediate breast reconstruction surgery at the same time as the mastectomy. This is especially true for patients with early-stage breast cancer who are not recommended to undergo radiation therapy. The need for post-operative radiation therapy is most often determined by the final breast cancer and lymph node pathology results.
Immediate versus delayed breast reconstruction
Following mastectomy, timing of breast reconstruction can be performed immediately or at a delayed time point. The need for radiation is not often known at the time of mastectomy to inform the decision
When deciding whether to undergo immediate or delayed reconstruction after a mastectomy for breast cancer, there are several factors to consider. The most important factor is whether or not you will need radiation. If you know you will need radiation, it is sometimes best to wait to have reconstructive breast surgery until after radiation is completed. This is because radiation can damage the skin and underlying tissues, making it more difficult to achieve a good result with reconstruction.
Another factor to consider is your overall health. If you are in good general health, you may be a candidate for immediate reconstruction. This can be done at the same time as the mastectomy, or within a few weeks afterward. However, if you have other health concerns that need to be addressed first, it may be best to wait until those are resolved before undergoing breast reconstruction.
Finally, it is important to consider your personal preferences and goals. Some women prefer to have breast reconstruction right away so they can feel “whole” again as soon as possible. Others may want to take some time to adjust to their new body before undergoing breast reconstruction surgery. There is no right or wrong answer – it is ultimately up to you what you feel best about.
If you are considering breast reconstruction after mastectomy surgery, talk to your plastic surgeon about what option would be best for you based on your individual circumstances.
Radiation may impact the outcomes of reconstruction, regardless of when it is performed.
Radiation therapy may impact the outcomes of breast cancer reconstruction, regardless of when it is performed. This is because radiation can cause changes in the tissues that are being treated, which can lead to problems with the reconstructed area. For example, radiation can cause scarring and stiffness in the tissues, which can make it difficult for the reconstructed area to heal properly. Additionally, radiation can damage blood vessels, which can lead to decreased blood flow to the reconstructed area and an increased risk of infection.
After severe radiation damage, breast implant reconstruction may not be possible or advisable due to damaged skin and soft tissue.
In such cases, the only option may be autologous reconstruction.
Immediate Reconstruction at the time of mastectomy is often performed before radiation.
For patients undergoing staged tissue expander-implant reconstruction, this may mean higher complication rates at the time of exchanging the tissue expanders for permanent saline and silicone implants. For patients that have direct to implant reconstruction or the final implant placed before reconstruction, the radiation may impact the final cosmetic result by altering the skin and capsule surrounding the implant, leading to distortion. Similarly, patients who have immediate reconstruction with autologous tissue may not have an optimal aesthetic result as the flap reconstruction is then radiated.
Autologous tissue breast reconstruction transfers healthy tissue from outside the area of radiation to replace radiation-damaged tissues, making breast reconstruction possible.
After severe radiation damage, implant based breast reconstruction may not be possible or advisable due to damaged breast skin and soft tissue. Radiation causes fibrosis and complications with wound healing due to damage to small blood vessels. Autologous tissue reconstruction transfers healthy tissue from outside the area of radiation to replace radiation-damaged tissues.
Autologous tissue breast reconstruction is a surgery that is used when patients have received extensive radiation treatment and as a result, their breast skin and soft tissues have been significantly damaged. This type of surgery is performed by taking healthy tissue from another area of the patient’s body and using it to replace the damaged tissue in the breast area. This surgery is often the only option for patients who have received extensive radiation damage and it can provide them with excellent results.
Common methods for autologous breast reconstruction by plastic surgeons include the use of a pedicled latissimus dorsi flap from the back or a free DIEP flap transferred from the lower abdomen.
Immediate autologous reconstruction can also be performed prior to radiation. While autologous tissue tolerates radiation better than implant reconstruction, the effects of the radiation on the final appearance of the autologous breast reconstruction can be variable.
Immediate autologous breast reconstruction can also be performed before radiation. While autologous tissue tolerated radiation better than an implant reconstruction, the effects of the radiation on the final appearance of the autologous breast reconstruction can be variable.
How long after radiation to wait until breast reconstruction is safe?
Women who have undergone radiation therapy for breast cancer often face the decision of whether or not to have breast reconstruction surgery. There are many factors to consider when making this decision, including the timing of the surgery concerning radiation therapy.
Radiation therapy can have many different effects on the body, including damage to skin and tissues. This damage can lead to delayed wound healing, and can also increase the risk of complications. For these reasons, it is generally recommended that women wait at least six months after completing radiation therapy before having breast reconstruction surgery.
Although many of the effects of radiation on the tissue are permanent, this waiting period allows the body time to heal from the acute effects of radiation therapy and decreases the risk of complications. It is important to speak with your breast reconstructive surgeon about your specific situation before deciding whether or not to have breast reconstruction surgery.
Why is it important to choose a board certified plastic surgeon?
It is important to choose a board certified plastic surgeon for any reconstructive or cosmetic procedure, including breast reconstruction. A board-certified plastic surgeon has completed a specific set of educational and training requirements that have been recognized by the American Board of Plastic Surgery (ABPS). This ensures that the surgeon maintains high standards in safety, experience and ethical practice, and is well-equipped to provide the best possible patient care.
Additionally, board certified plastic surgeons are required to follow all the necessary safety protocols and use modern techniques when performing any breast reconstruction procedure, including immediate and delayed reconstruction. Choosing a board certified plastic surgeon can give breast reconstruction patients greater confidence in their care and help them achieve the desired outcome, regardless of breast reconstruction method (flap reconstruction versus implant procedures), on their journey recovering from breast cancer.
