Mastectomy Radiation Archives - Breast Reconstruction Associates

I’ve Had a Lumpectomy and Radiation Previously but Now I Need a Mastectomy. What Should I Know?

Written by Breast Reconstruction Associates on January 17, 2024. Posted in Mastectomy Radiation.

Lumpectomy and radiation, also known as Breast Conservation Therapy (BCT), is an increasingly common way to treat breast cancer, especially in women with larger breasts and smaller tumors. Although BCT has similar survival rates compared to women who undergo mastectomy and reconstruction (usually without radiation), there is a higher local recurrence rate for breast cancer in the same breast after BCT.

For women who have had BCT previously but now have a new breast cancer in the same breast, another lumpectomy with radiation is not possible. For this reason, women are best counseled to treat their new cancer with mastectomy. Although hormornal or chemotherapy may be indicated, radiation is usually not able to be given a second time.

For women undergoing mastectomy in this scenario, reconstruction with an expander or implant has a much higher rate of infection and reconstruction failure compared to women who undergo microsurgical breast reconstruction using their own tissues. For this reason, we strongly counsel women to consider free flap breast reconstruction. Depending on the previous scars present and the tissue quality, skin sparing mastectomy might still be possible.

Radiation and Tissue Expander; What Should I Know?

Written by Breast Reconstruction Associates on April 14, 2023. Posted in Mastectomy Radiation, Radiation Therapy.

The indications for radiation therapy after mastectomy may include larger tumor size, nodal metastasis, or involved or close surgical margins. In some scenarios, the need for radiation is known prior to the mastectomy, and in other cases, it’s not determined until after the mastectomy, when the final pathologic stage is determined.

Occasionally, a tissue expander, which is a temporary implant, may be used as a placeholder at the time of the mastectomy to allow for further cancer treatment, i.e. chemotherapy and/or radiation therapy. The tissue expander helps preserve more skin on the chest wall and creates a temporary breast mound during cancer treatments so that you feel and look normal in clothing.

After all the treatments are concluded, the tissue expander is then exchanged for either an implant or tissue-based reconstruction. Patients who elect to have a permanent implant placed are at higher risks for both short-term and long-term complications. Short term complications include infection and extrusion of the implant while long term risks include an accelerated progression to capsular contracture. Tissue-based reconstruction offers a safer alternative for patients requiring radiation therapy after a mastectomy as the overall complications do not differ from non-radiated patients.

The decision to use a tissue expander is unique to each patient as it is influenced by the overall cancer treatment plan. Please contact us at Breast Reconstruction Associates so we can work with you, your breast surgeon, and your radiation oncologist to determine the best reconstruction strategy.

I’ve Had (or Need) Post-Mastectomy Radiation, What Are My Reconstructive Options?

Written by Breast Reconstruction Associates on March 3, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction, Mastectomy Radiation.

Radiation is a mainstay of treatment for breast cancer and is sometimes required after a total mastectomy. Even though the breast is gone, the chest wall including the skin and underlying pectoralis muscle as well as regional lymph nodes may benefit from radiation. The need for post-mastectomy radiation will be determined by your final surgical stage.

Radiation therapy can pose challenges for implant-based reconstruction as it leads to higher rates of implant failure requiring subsequent surgeries to remove or exchange the implant. Complications after radiation also include pain, delayed healing and infection, and accelerated progression to capsular contracture. In patients who have previously been treated with radiation or know post-mastectomy radiation is planned for a current cancer diagnosis, autologous reconstruction (meaning using tissue from one’s own body) is the preferred approach over implant-based reconstruction.

At Breast Reconstruction Associates, our preferred donor site for autologous reconstruction is the lower abdominal skin and fat (DIEP flap) as enough skin and fat can usually be harvested to reconstruct a breast without the need for an implant. However, there are other donor site options available if you’re not a candidate for the DIEP flap, e.g. previous abdominoplasty. Rarely, an augmentation implant may be combined with your own tissue to complete the reconstruction process.

If you previously underwent a mastectomy without reconstruction followed by chest wall radiation, you can proceed with autologous reconstruction even years later. Autologous reconstruction brings soft, non-radiated skin and fat to the chest wall to help create a new and more natural-appearing breast mound.

For patients with a current breast cancer diagnosis requiring radiation therapy, autologous reconstruction can be done immediately at the time of the mastectomy or in a delayed fashion once all cancer treatments have been completed. This decision is made on a case by case basis between you, your plastic surgeon and breast surgeon. If a delayed approach is considered, then the final reconstruction usually occurs 3 to 6 months after completing radiation therapy.

The differences between a Lumpectomy with Radiation Therapy and a Mastectomy with Reconstruction

Written by Breast Reconstruction Associates on July 14, 2022. Posted in Mastectomy Radiation, Radiation Therapy.

Lumpectomy vs Mastectomy – What’s the difference?

A lumpectomy, or ‘partial’ mastectomy, is the removal of only a portion of the breast – specifically the tumor and a normal rim of breast tissue immediately surrounding the tumor. This is an option for cancer treatment and is followed by breast radiation to lower rates of recurrence. The combination of ‘lumpectomy + radiation’ is frequently referred to as ‘breast conservation therapy’ or ‘BCT’.

A mastectomy is the removal of the entire breast. In many cases, this eliminates a patient’s need for radiation therapy.

Cancer considerations

The size and location of a breast tumor determine if a patient is a candidate for breast conservation therapy. When considering BCT, breast surgeons are weighing complete clearance of cancer with the maintenance of an aesthetically satisfactory breast. Though a mastectomy is always an option to treat breast cancers, most breast surgeons treat more than 50% of patients with breast conservation therapy.

When deciding between these two approaches, patients are counselled that BCT and mastectomy have equivalent outcomes with regards to survival, but that BCT is associated with a higher rate of local recurrence.

Cosmetic Considerations

In general, when deciding between these two approaches, reconstructive surgeons are focused on optimizing the aesthetics of the breast, including consideration of volume, shape, and symmetry.

If you are a candidate for either surgical option, the tumor size and breast size are the main variables we consider when determining the most optimal cosmetic approach for you.

If the tumor is small and the breast is large, then only a small percentage of the breast would need to be removed. In such a case, BCT is often a good choice. If needed, the other breast can be reduced or lifted for purposes of symmetry. It is important to note, that the final appearance of the cancer breast may be impacted by radiation therapy. In the long-term radiation can cause volume loss and skin tightening of the breast, these changes can impact symmetry over time.

For women with small or moderate sized breasts, even a small tumor could require removal of a significant amount of the total breast volume, leading to a breast deformity or significant asymmetry. In such cases, a mastectomy with reconstruction may provide a better cosmetic result. A balancing breast lift of the other breast can also be performed simultaneously for symmetry purposes. In some circumstances, radiation can be avoided after mastectomy, which eliminates the possibility of future asymmetry caused by radiation.