I’ve Had (or Need) Post-Mastectomy Radiation, What Are My Reconstructive Options?
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.
FAQs
Even after the breast is removed, radiation may still be recommended to target the chest wall — including the skin and pectoralis muscle — as well as regional lymph nodes. The need for post-mastectomy radiation is determined by the patient’s final surgical stage.
Radiation increases the risk of implant failure, which may require additional surgeries to remove or replace the implant. It can also cause pain, delayed healing, infection, and accelerated capsular contracture, making implants a less favorable option for patients who have had or will need radiation.
Autologous reconstruction uses the patient’s own tissue — such as skin and fat — to rebuild the breast. It is preferred over implants for patients with a history of radiation or planned post-mastectomy radiation because it brings soft, healthy, non-radiated tissue to the chest wall, resulting in a more natural appearance with fewer complications.
The DIEP flap uses skin and fat from the lower abdomen as the donor site. It is the preferred approach at Breast Reconstruction Associates because it typically provides enough tissue to reconstruct the breast without needing an implant, offering a natural and lasting result.
If you are not a candidate for a DIEP flap for example, if you’ve had a previous abdominoplasty other donor site options are available. In rare cases, a small augmentation implant may be combined with your own tissue to complete the reconstruction.
Yes. Autologous reconstruction can be performed even years after a mastectomy and chest wall radiation. The procedure brings in soft, non-radiated tissue to help create a new, natural-looking breast mound, regardless of how much time has passed.
This is decided on a case-by-case basis in consultation with your plastic surgeon and breast surgeon. Reconstruction can be done immediately at the time of mastectomy or delayed until all cancer treatments are finished. If a delayed approach is chosen, the final reconstruction typically takes place 3 to 6 months after completing radiation therapy.