Breast Reconstruction After Radiation

Radiation is an important therapy option commonly used for treating breast cancer in many patients; it also has very damaging effects of healthy breast, fat and skin tissues. Radiation is helpful in that it damages the cancer cell's ability to reproduce (which is why it is so commonly used) however, all the non-cancerous tissues are also damaged or changed permanently.

The level of breast reconstruction needed will depend on the procedure administered to remove the cancerous tissue in the first place, and all three scenarios should be discussed with your surgeon:

1.) Immediate reconstruction after mastectomy (complete removal of breast), followed by radiation treatment

2.) Mastectomy and radiation followed by reconstruction (though Doctors generally prefer to wait 3 to 6 months)

3.) Lumpectomy (partial removal of breast) with radiation followed by reconstruction

Obstacles the arise when working with skin that has been radiated is that it loses a lot of its elasticity, and ability to heal itself well causing increased bleeding issues leaving a patient more susceptible to bruising and wound complications.

More often than not, microsurgeons try to save as much tissue as possible during the mastectomy. Called “skin sparing mastectomy” it helps with the reconstructive process compared to full-removal mastectomies. However, the “spared tissue” still undergoes changes during the radiation process. For some women, the idea of coming out of procedure and not having a breast at all is more psychologically damaging, so they choose to have reconstruction prior to radiation. This option can certainly be considered as long as the patient understands there is the potential for changes in the breast's appearance and feeling once radiation is administered.

Another way to have a more successful breast reconstruction after radiation is with the use of DIEP, TUG or SIEA flaps, where healthy tissue from the abdomen or inner thigh is removed to form a new breast. The major benefit to this type of procedure is it helps aid in the healing process by bringing healthy, non-radiated vascular tissue to the area. It also has better aesthetic results as a lot of the radiated skin is removed allowing the surgeon to shape a more natural looking breast.

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