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.