HomeHealth articlesbreast reconstructionWhat Are the Consequences of Radiotherapy for Breast Reconstruction?

Consequences of Radiotherapy for Breast Reconstruction

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Read the article below to know more about the short and long-term effects of radiotherapy on breast reconstruction.

Written by

Dr. Pallavi. C

Medically reviewed by

Dr. Dhepe Snehal Madhav

Published At February 7, 2023
Reviewed AtApril 26, 2023

Introduction

Breast reconstruction is a surgical procedure that involves restoring the shape and form of the breast after mastectomy; caused due to cancer. Plastic surgeons and breast surgeons do this procedure. Both of them should cooperate for the most significant outcomes.

This procedure is done in two stages; sometimes, multiple operations may be needed. This procedure involves implant-based or autologous tissue reconstruction depending on the patient's condition. Breast reconstruction surgery does not produce the exact natural shape and form of the breast but mimics the contour of the breast shape after a mastectomy.

Radiation therapy eliminates latent illness and serves as a support for surgically removing the tumor. Patients with positive nodes, locally progressed disease, and large tumor size benefits from radiation. However, there is a general trend toward a lower threshold for the administration of radiation to patients with breast cancer. Since radiotherapy is frequently administered after mastectomy rather than before, post-mastectomy radiotherapy has become well-known (PMRT).

Radiation therapy may negatively affect the appearance, cause infections or other problems, or even cause the reconstruction to fail.

What Are the Different Types of Breast Reconstruction Procedures?

  • Implant-Based Reconstruction: This procedure involves the placement of either saline or silicone gel implants to render a more aesthetic appearance to the breasts. This procedure is done either after mastectomy in cancer patients.

  • Autologous Tissue Reconstruction: is generally referred to as the benchmark of breast reconstruction, which involves recreating the breast tissue using the patient's tissues. It entails moving bodily tissues, such as skin, fat, and occasionally muscle, to the breast. Autologous reconstruction produces soft tissue that is adequately vascularized and resembles normal breast tissue. It is easily sculptable and yields a more natural appearance.

  • Delayed Immediate Reconstruction: This procedure is done a few months after the mastectomy. A tissue expander is inserted in the first phase under the skin, and a mastectomy procedure is performed after a few months. In subsequent visits, the tissue expander is filled with saline, so the skin is pulled along with the expander. Once the desired size is reached, the surgeon will perform the second stage of surgery, where an implant precedes the tissue expander.

  • Reconstruction with Fat: From filling in gaps left by partial mastectomies to serving as an adjuvant to implant- or autologous-based repair to serving as the sole reconstruction technique in some circumstances, fat grafting has played a significant and contentious role in breast reconstruction. The fat grafting-only repair can be effective for patients with tiny breasts, particularly in unilateral situations.

What Are the Consequences of Radiotherapy for Breast Reconstruction?

Both the short and long-term results of the restoration are impacted by radiation therapy. Regardless of the reconstructive method, patients experience excellent infection rates, flap failures, exposure, loss of repair, and capsular contracture. The patient's satisfaction could be better.

Asymmetrical Breasts:

After radiotherapy, a rebuilt breast frequently gets firmer and sits higher on the chest. If a patient has a tissue flap, implant, or capsular contracture, the radiation therapy produces skin shrinkage, resulting in breast asymmetry.

The breast that had radiation treatment could appear very different from the one that did not. In that case, the plastic surgeon might advise having a breast lift on the non-irradiated chest so that it more closely resembles the radiated breast. If a patient has capsular contracture in the radiation-damaged breast, the plastic surgeon may or may not, depending on whether it is bothering the patient and changing the contour of the breast, might advise treating it.

Flap Failure:

This is caused due to the infection at the site, which results in insufficient blood supply and causes loss of the flap. This results in rupture or leakage of implant or shrinkage of breasts.

Flaws in the Tissues and Skin Around the Prosthesis

The skin covering a prosthesis or tissue flap may grow thicker, firmer, and more rigid due to radiation. Fat grafting, often known as "fat injection," is a procedure that, in some circumstances, can help soften and enhance the skin and strengthen the layer of tissue between the skin and the implant.

In a fat grafting treatment, liposuction removes fat tissue from another area of the body, typically the patient's thighs, abdomen, or buttocks. The liquidized tissue is subsequently processed and administered into the breast region. Within a few days, the fat that remains forms a blood supply. In some instances, hardly any of the fat or approximately half of the fat injected will, in the best case scenario, remain there forever, with the remaining half being absorbed back by the body. For the best results, fat grafting may require multiple procedures.

If patients are thinking about getting fat grafted, discuss if they can expect the results they want with their plastic surgeon. Even though fat grafting is utilized to correct skin and tissue flaws following radiation therapy, radiated tissue does not take fat grafting as well as non-radiated tissue. It is also crucial to understand that a patient cannot use tissue or fats from a donor region on the body, like the belly, after removing it for fat grafting for breast reconstruction.

Effect of Radiation on Normal Tissues

Radiation exposure can harm soft tissue biology, healing, and vascularity. These effects have been thoroughly researched and described. The skin impacts of radiation can be divided into two categories.

  • Acute Damage: This damage is characterized by erythema and swelling and typically heals after therapy. Once the effects of radiation have clinically subsided may help avoid surgical difficulties.

  • Chronic Damage: This damage frequently results in the dermis and subcutaneous becoming dry, hypopigmented, and eventually fibrosing and hardening. Late radiation tissue injury (LRTI), the term for chronic damage, can appear months or years after the initial radiation exposure.

Conclusion

These worries are somewhat allayed but not fully addressed by more targeted radiation delivery and improvements in breast reconstruction techniques. Many studies have claimed that delayed immediate reconstruction was effective as it was performed a few days after mastectomy. The primary objective of the plastic surgeon is to produce a satisfactory reconstructive result without compromising the oncologic aspect.

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Dr. Dhepe Snehal Madhav
Dr. Dhepe Snehal Madhav

Venereology

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