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.