A breast cancer diagnosis can be overwhelming. Important decisions need to be made quickly. A large amount of information comes at you all at once. Your medical team will walk you through choosing the best course of treatment so as to minimize the risk of cancer returning or spreading. If you are considering breast reconstruction after radiation, the time to talk about it is now.
As you work through these decisions, it’s important to start having conversations immediately with your medical team about the possibility of breast reconstruction. If radiation therapy is a part of your treatment plan, there will be special considerations to take into account.
How Radiation Works
Radiation therapy has been used to treat breast cancer for more than 100 years, according to Radiation Oncology, UCLA. Radiation therapy uses a high energy beam to destroy cancer cells. It acts directly on the cell’s nucleus. In so doing, radiation significantly damages or destroys the DNA of whatever cells it touches. It renders the cell unable to divide, and prevents the growth and spread of those nasty cancer cells. This type of treatment is an extremely effective way to kill the cancer cells that remain in the breast after surgery. Today, it is a routine part of breast cancer treatment in situations where a woman chooses a “breast conserving” lumpectomy. It is also routine when multiple lymph nodes are positive, or if the cancer is localized.
Radiation and Reconstruction: The Challenge
What makes radiation tricky with breast reconstruction is that it will also damage healthy cells, such as in the skin. Thus, when paired with breast reconstruction surgeries, it can also result in a greater chance of complications. Complications like infections, delayed healing, wound breakdown, and fat necrosis (small hard nodules of fat inside the breast). Additionally, radiation can cause the skin and muscles to be less elastic or stretchy. If implants are already in the breast at the time of radiation, it may also alter how the implants look.
Breast Reconstruction After Radiation, or Before?
When cancer found in the breast is larger than 5 centimeters, and has spread to lymph nodes, treatment is more likely to include radiation. Many women aren’t aware of all their options for reconstruction at the time of their breast surgery. It’s important to know that you can choose between breast reconstruction after radiation therapy or before it. However, there are some things to consider when choosing the best time to begin reconstruction.
Radiation after breast reconstruction can cause the reconstructed breast to lose volume. Radiation could change texture, appearance and color of the reconstructed breast. Additionally, research has suggested that in some cases breast implants, if used, can interfere with the radiation actually reaching the areas affected by cancer. However, this varies patient to patient. Some surgeons will advise their patients to wait until after radiation, which could put off reconstruction 6 to 12 months.
If you’re having radiation therapy after a mastectomy, staged breast reconstruction or delayed-immediate reconstruction may be a great option. In staged breast reconstruction, a tissue expander is inserted under the chest wall during the mastectomy. The expander works like a balloon, stretching the skin slowly, as it is filled over several weeks or months. This creates a pocket for the reconstructed breast under the skin. The expander can also be used to preserve the breast shape and skin during radiation therapy. Once the radiation is complete, it takes about 4-6 months for the tissues to recover.
When reconstruction needs to occur before radiation treatment, autologous reconstruction is an option. This method uses a woman’s own tissue to reconstruct the breast. Fat and skin can be removed from the abdominal area, the back, or the butt. This method has a lower risk or a less serious risk with radiation than breast implants. Operations for tissue transfer are often longer and more extensive procedures. Some women aren’t candidates for the procedure because they don’t have enough fat and skin to build the breast to desired size. Complete loss of an autologous reconstruction from radiation does not occur, while it can occur with implants.
It’s important to remember that knowledge is power. By gathering information on timing and types of breast reconstruction, you can be confidant the choices that you make with your physician are the right ones. For more information about the variety of breast reconstruction options, whether or not you are considering breast reconstruction after radiation, click here.