Radiation and Reconstruction

The treatment of breast cancer almost always involves surgery- either a partial (where only the portion of the breast containing the tumor is removed) or total mastectomy (where the entire breast is removed). Other common treatments include chemotherapy and radiation. These are administered based on the size of the tumor, on the microscopic appearance of the tumor cells, or whether cancer cells have affected the lymph nodes. The role of radiation is to eliminate any microscopic, “stray” cancer cells not removed by the partial or complete mastectomy. It is a very effective treatment in patients with certain types of cancers.

Radiation, however, can have serious negative effects on breast reconstruction. Radiated skin and tissues do not heal the same way that non-radiated tissues do. Often, radiated skin and tissues become discolored, tight, and rigid. These changes are most often permanent and do not improve with time. In addition, the risk of complications such as bleeding, infection, fat necrosis, or wound breakdown is increased in radiated breasts.

Implant-based reconstruction in patients who have received or will receive radiation should be approached with great care, as excess scar tissue can build up around the implant, causing a capsular contracture. These capsular contractures can give the impression that the implant has hardened, leading to discomfort or even deformity of the reconstruction. Therefore, it is often better to perform autologous reconstructions in patients AFTER they have received radiation. Again, it is important to rely on the expert advice of your plastic surgeon to help you navigate these complex waters!