October 3, 2012

Implanting Knowledge Before Breast Reconstructive Surgery

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Joseph V. Madia, MD By:

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Breast cancer implant reconstructive surgery after radiation has risks

(dailyRx News) Radiation is used after breast cancer surgery to kill any remaining cancer cells. It’s given after both lumpectomy (breast-conserving surgery) and mastectomy that removes the entire breast. Radiation therapy can and does have an impact on breast reconstruction.

Using implants for breast reconstruction causes more problems for women who have had radiation following their mastectomy.

"Rely on an experienced board-certified plastic surgeon."

Steven J. Kronowitz, MD, FACS of The University of Texas MD Anderson Cancer Center, reviewed recent research to draw these conclusions.

In the October issue of Plastic and Reconstructive Surgery, Dr. Kronowitz wrote that despite these risks, breast reconstruction using implants is successful in most women who have undergone radiation therapy.

Radiation following a mastectomy is being used more frequently to reduce the chances of the cancer returning. This is called post-mastectomy radiation therapy, or PMRT.

Exposing sensitive breast tissue to radiation can cause difficulties, including skin and healing problems.

This is why most reconstructive surgeons agree that using the patient’s own (autologous) tissue is the best alternative following PMRT. However, this option isn’t always available or possible.

“The take-home message for breast cancer patients who require radiation is they should be counseled that implants will have a higher chance of complications and possible major corrective surgery than autologous reconstruction [using the patient's own tissue]…," Gedge Rosson, MD, director of Breast Plastic Surgery at Johns Hopkins, told dailyRx news.

Dr. Kronowitz’s looked at how patients fared with implant reconstruction following radiation in 19 studies. Here’s what he learned:

  • The risk of major complications was 45 percent in patients who had received radiation compared to 24 percent who had not.
  • Complications were more likely to occur when the radiation was given before (64 percent) rather than after (58 percent) the implant surgery.
  • Patient satisfaction was lower in women who had implant reconstruction after radiation than those who did not have the therapy. 
  • More women in the radiation group were at higher risk of needing additional surgery than those in the non-radiation group.
  • Some of the studies found that adding a woman’s own tissue – along with the implant – produced better results.
  • Results tend to be better when the surgery happens after the radiation instead of just after the mastectomy.

"Despite advances in reconstructive devices and materials, PMRT still appears to have an adverse impact on outcomes of implant-based breast reconstruction," Dr. Kronowitz wrote.

He thinks that using what’s called autologous fat grafting and other new techniques can improve the outcomes of implant surgeries.  

“For various reasons, some women will still choose implant-based reconstruction, and if that's the case, it is important for her to see a plastic surgeon well-versed in these subtleties and new techniques, such as fat grafting, for example," said Dr. Rosson, who is associate professor of plastic and reconstructive surgery at the Johns Hopkins School of Medicine.

“If possible, breast cancer patients should seek advice from a board-certified plastic surgeon with a high-volume breast reconstruction practice that is part of a well-coordinated breast center,” he said.

Plastic and Reconstructive Surgery is the official medical journal of the American Society of Plastic Surgeons (ASPS).

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
October 3, 2012

Last Updated:
July 5, 2013