Reconstruction and Radiation Therapy
Some women who need mastectomies also need radiation therapy. This can complicate their choices and decisions about reconstruction. Radiated tissue does not ever respond as it did before the treatment, and these changes often limit reconstruction possibilities. Specifically, many plastic surgeons are unwilling to use the tissue expander technique for women post radiation, finding that the chest wall tissue does not expand and heal as it needs to for a successful reconstruction. This has led to some women having the first stage of an expander/implant reconstruction prior to radiation therapy. There have been questions about this practice, and a new study from Penny Anderson and her colleagues at Fox Chase has brought reassurance to women who have made that choice.
Like everything else, this remains an individual situation and decisions must be carefully made with your doctors.
Reconstruction delay unnecessary for postmastectomy radiotherapy
By Lynda Williams
16 April 2009
Int J Radiat Oncol Biol Phys 2009; 74: 81-85
MedWire News: Women who receive radiotherapy after reconstructive surgery do not have a higher rate of major complications than those who delay the cosmetic procedure, US researchers have found.
Some physicians recommend that patients likely to require radiotherapy delay reconstructive surgery until treatment is completed, the team explains in the International Journal of Radiation Oncology Biology Physics.
"This approach precludes the cosmetic advantages of a skin-sparing mastectomy, subjects the patients to a second major operative procedure, and may delay the performance of reconstruction for as long as 2 years," write Penny Anderson and co-workers, from Fox Chase Cancer Center in Philadelphia, Pennsylvania.
To investigate further, the team reviewed medical records for 74 breast cancer patients who underwent modified radical mastectomy followed by breast reconstruction and radiotherapy. Reconstruction was most commonly a temporary tissue expander (TTE) followed by a permanent implant (PI) and radiotherapy was delivered to the TTE in 62 patients and the PI in 12. The patients received a radiation dose of 50 Gy to the chest wall and were followed-up for a median of 48 months.
Anderson et al found no significant difference in the rate of complications among patients given radiation with the PI and TTE (0% vs 4.8%), and while the three patients with major complications to the TTE lost their implant, none of the PI patients lost their reconstruction.
Furthermore, good or excellent cosmetic scores were achieved by 90% of the TTE and 80% of the PI patients. Neither patient- nor treatment-related factors affected the likelihood of a good or excellent cosmetic outcome.
"Our study demonstrates that postmastectomy radiation therapy can be delivered to patients with breast reconstructions with very low rates of complications," Anderson et al write.
They add: "In our practice, we offer postmastectomy radiation therapy to patients with either a TTE or a PI. The need for postmastectomy radiation therapy is not an indication for removal of a temporary tissue expander or a permanent implant and should be considered in all eligible patients