Radiation may be used in the treatment of some women with breast cancer. A targeted beam of radiation is directed to the chest, and sometimes to the armpit, in order to help rid the body of microscopic tumor cells. Although normal cells are less susceptible to the effects of radiation than the cancer cells, they are not unaffected. Non-cancerous tissues that are in the path of the radiation are changed permanently. In particular, there is a significant loss of skin elasticity that can profoundly affect the aesthetic results of a breast reconstruction in women who are treated with radiation. In addition, there may be more complications when radiation follows reconstructive breast surgery of all types, because the body’s wound-healing mechanisms are altered by exposure to radiation.
Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Some of the complications that occur at higher rates in patients who receive with radiation with implants include wound breakdown, delayed healing, infection, breast implant or tissue expander extrusion, and severe capsular contracture. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascular tissue into the radiated area which can actually aid in the healing process. Because of the potential complications associated with implants, breast reconstruction using natural tissue is generally considered the best method for women who will require or have already had radiation.
The need for radiation to treat the cancer may thus be a factor in determining if a woman will undergo an immediate or delayed breast reconstruction and also in determining which method of reconstruction she chooses.
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.
Ideally, to achieve the best cosmetic results with the lowest rate of complications, we like to wait approximately six months before performing a perforator flap reconstruction when a woman has had radiation to her breast or chest; this time period may vary depending on a woman’s particular circumstances. Some of the radiation-damaged skin can be replaced with soft and supple skin that allows for the shaping of a much more natural appearing breast. Furthermore, if reconstruction is delayed until after radiation is completed, the tissue used for the reconstruction is not exposed to any radiation that could potentially affect it.
The need for radiation therapy cannot always be determined prior to surgery. This is because evaluation of a mastectomy specimen by a pathologist may uncover certain findings that lead to the determination that radiation is needed to optimally treat a woman’s cancer. Consequently, on occasion, a woman may have already begun the reconstructive process when she learns that she will undergo radiation treatment. Since treatment of the cancer takes precedence, radiation will be administered and if necessary appropriate measures will be taken to optimize the final reconstruction and manage any complications that arise.