When radiation is used in the treatment of breast cancer, non-cancerous tissues in the path of the radiation are also affected. Radiation therapy can mean a significant loss of skin elasticity, which can profoundly affect the aesthetic results of breast reconstruction. 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.
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.
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.
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. Perforator flaps including the DIEP flap, SIEA flap and SGAP flap are all used routinely with excellent results to reconstruct patients who have required radiation therapy.
The need for radiation may, however, be a factor in determining if a woman will undergo an immediate or a delayed breast reconstruction; radiation may also influence which method of reconstruction she chooses.
Ideally, to achieve the best cosmetic results and minimize the chances of complications, we prefer to wait approximately six months before performing a perforator flap reconstruction when a woman has had radiation therapy. This time period may vary, depending on each woman’s particular circumstances. By waiting, we can 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. Nevertheless, in certain circumstances, reconstruction can still be done ahead of radiation.
The need for radiation therapy cannot always be determined prior to mastectomy surgery. And on occasion, a woman may already have begun the reconstructive process after mastectomy when she learns that she will need to undergo radiation treatment. Since treatment of the cancer takes precedence, radiation will take place whenever the oncologist thinks it best, and our practice will take all appropriate measures to manage any complications that may arise and to optimize the final reconstruction.