Implants a poor choice for reconstruction when radiation treatment required

Providing the Best in Natural Breast Reconstruction to Orlando & nearby areas of Florida

Sun, 10/20/2013

It has long been my impression that breast reconstruction with expanders and/or implants is a poor choice when radiation therapy is required as part of the breast cancer treatment. A recent review of the literature published in the Journal of Plastic and Reconstructive Surgery, confirms this. In their review of the literature, the authors found a 5 to 6 times higher complication rate with implants and expanders when the patient has had radiation treatment as part of their breast cancer treatment.

(The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review. By Lam, Hsieh and Boyages)

In contrast, autologous fat transfer has been shown to regenerate healthy normal tissue which has been damaged by radiation therapy, and can be used as the primary reconstruction method, or to salvage failed implant reconstruction.

Complications with implants range from poor cosmetic results, to severe capsular contracture (hardening), infection and total loss or removal of the implant.

In the last 15 years, expander / implant reconstruction has become the most common type of reconstruction offered to women with breast cancer. It is my opinion that expander and implant reconstruction is a poor option when there is a possibility that radiation therapy may be beneficial to treat the cancer and prevent recurrence. Many women are offered immediate breast reconstruction with expander and implant placement before the need for radiation therapy is ruled out. This occurs because frequently radiation therapy is recommended only after all the tissue and lymph node testing is completed after the mastectomy. If an expander or implant is placed at the time of mastectomy, and then it is decided afterwards that radiation therapy is required, there is a significant risk that there will be complications with the expander or implant. In my opinion, implant/expander reconstruction should only be contemplated if there is no possibility of the patient requiring radiation therapy after the mastectomy.

Immediate reconstruction with autologous fat transfer (AFT) can be initiated at the time of mastectomy, without the risk of the complications seen with implants. Initial data indicates that AFT may actually mitigate some of the adverse effects of radiation, and this is particularly the case with AFT reconstruction done in women who have already completed radiation therapy.

Another common problem is women who have breast implants placed for cosmetic breast augmentation, and who later develop breast cancer. These women will frequently be treated with lumpectomy and radiation, again with a high complication rate related to their previously placed implants. These women will frequently require removal of their implants. In these cases the only logical method of reconstruction for their breast deformity is AFT, as the only other option would be some form of large tissue flap transfer. Some surgeons have even recommended full mastectomy and flap reconstruction for these patients, which of course negates the benefit of lumpectomy and radiation as a breast sparing procedure in the first place.

Before you consider, immediate expander / implant reconstruction be sure that radiation therapy is unlikely to be part of your recommended treatment, and consider autologous fat transfer as an option. At the Breast Center at the Bougainvillea Clinique, we are able to offer mastectomy or lumpectomy procedures, with initiation of immediate reconstruction with AFT. We are happy to consult with you on your options, and we recommend that women diagnosed with breast cancer explore all their options for breast reconstruction, including AFT.Even though the diagnosis of breast cancer is extremely traumatic for women , we also strongly recommend exploring these options, immediately when you are diagnosed, and not later after treatment and reconstruction have been initiated. Call or email us for more information about your options and the benefits of AFT.

4355 Bear Gully Road
Winter Park, FL 32792