Sometimes, a breast cancer patient will be offered radiation in addition to surgical therapy to give her optimal opportunity to avoid recurrence of her cancer. Radiation is typically delivered only to the breast and armpit area on the side of the cancer.
While undergoing treatment, the radiated area can become red and inflamed, similar to a severe sunburn. Months to years after undergoing treatment, additional changes arise. Typically, the skin and other involved tissues lose their elasticity and draw tighter after radiation. Tissues that are usually soft can become hard or “woody”. This loss of suppleness in the skin and tissue causes a parallel drop in the aesthetic and natural qualities of a patient’s breast reconstruction.
When a tissue expander or implant is used in breast cancer reconstruction, all patients will form a layer of scar tissue around the implant. This is called a scar capsule or peri-prosthetic capsule and it is a normal response in all patients. In some patients, however, the scar will become thickened and contract, causing deformity, loss of malleability, and malposition of the involved implant. This can require revision surgery. After radiation, this contracting process is not only more likely to occur, but also to be more severe. For this reason, patient satisfaction tends to be lower with implant than soft tissue-based reconstruction when radiation is necessary.
Occasionally, the need for radiation is not anticipated until after the mastectomy and lymph node biopsy have been performed in conjunction with an immediate reconstruction. A patient and her surgeon will then need to decide if she should continue along the path towards final implant reconstruction or change to natural tissue reconstruction. In either case, the next surgical step is generally taken after radiation has already been completed.
Additionally, in patients whose older reconstructions have been fouled by radiation, there may be a possibility for revision of her reconstruction with conversion to natural tissue methods. Thus, healthy, unradiated tissue from the abdomen or other area can be used to replace the tight, firm, radiated tissue of the breast, whether a previous reconstruction is no longer acceptable or no reconstruction was previously performed.
Radiation And Tissue Expanders: What Should I Know? – Christine Fisher MD