Procedure
Radiation and Breast Reconstruction
Radiation therapy, a common treatment for breast cancer, can impact the outcomes of breast reconstruction following mastectomy. The effects of radiation on tissues, particularly scarring and reduced tissue pliability, may influence the success of reconstruction. The timing of radiation in relation to reconstruction and the choice between implant-based and autologous reconstruction are crucial considerations. Complications such as delayed healing, infection, implant exposure and changes in appearance may arise. Irradiated skin may become stiff and difficult to expand with tissue expander. Effective communication between the breast cancer surgeon, radiation oncologist, and plastic surgeon is vital for informed decision-making, and patients should be aware of the potential challenges and benefits when considering the combination of radiation and breast reconstruction. Individual factors, cancer type, and overall health play a role in determining the most suitable approach. These cases are challenging and requires specialized knowledge and experience. Breast reconstruction with implant after radiation is a special area of interest for Dr. Sahar. These cases may require multiple operations, including fat grafting to improve quality of tissues prior to placing implants. Dr. Sahar is not only a specialist in breast reconstruction; he has over a decade of experience successfully reconstructing breasts with implants in setting of radiation and conducted scientific research in studying safety of fat graft in the setting of breast reconstruction. (2015, 2018)
Radiation therapy is a common component of breast cancer treatment, often used to destroy cancer cells and reduce the risk of cancer recurrence. However, it can have implications for breast reconstruction if reconstruction is being considered following mastectomy. Here are some key points regarding radiation and breast reconstruction:
- Effect on Tissues: Radiation therapy can affect the quality of tissues, making them less pliable and more prone to scarring. This can impact the success and outcomes of breast reconstruction.
- Timing of Radiation: The timing of radiation in relation to breast reconstruction is an important consideration. In some cases, radiation is administered before reconstruction, while in others, it may follow the reconstruction.
- Tissue expander/Implant Breast Reconstruction: If radiation occurs after breast reconstruction with implant is completed, significant changes including tightening/constriction and higher position of implant on the chest may occur, causing significant asymmetry compared to the non-radiated breast. This maybe be addressed to some extent through surgery and fat grafting. Any surgery should be delayed for about a year after the last dose of radiation to reduce risk of complications. If radiation is started after placement of tissue expander, replacement of tissue expander for permanent implant is delayed for a year. There are pros and cons regarding radiation after tissue expander placement vs after replacing tissue expander for permanent implants. The risk of complication are higher after former, but the aesthetic results tend to be better.
- Autologous Breast Reconstruction: Autologous reconstruction, where tissue is taken from another part of the body (usually the abdomen or back) to reconstruct the breast, is another option after radiation treatment. Sometimes using autologous tissues are the only way to reconstruct a breast due to quality of skin and subcutaneous tissue. The impact of radiation on these tissues should be taken into account when planning this type of reconstruction.
- Complications: Radiation can increase the risk of complications in breast reconstruction, such as delayed wound healing, increased scarring, and changes in the appearance of the reconstructed breast. It may also affect the long-term cosmetic outcomes.
- Consultation and Planning: Communication between the breast cancer surgeon, radiation oncologist, and plastic surgeon is essential for effective planning. A comprehensive discussion about the potential impact of radiation on reconstruction options, the timing of treatments, and the patient's circumstances is crucial.
- Patient Considerations: Patients should be well-informed about the potential challenges and benefits of combining radiation therapy with breast reconstruction. Factors such as the type of cancer, the extent of surgery, and individual health considerations play a role in decision-making.
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