September issue of Plastic and Reconstructive Surgery Journal had an article on radiation timing with implant reconstruction. Does it make a difference if you radiate before mastectomy? After? Is one better?
The article was “Immediate Implant Based Breast Reconstruction following Total Skin Sparing Mastectomy: Defining the Risk of Preoperative and Postoperative Radiation Therapy for Surgical Outcomes.” It was a study out of UCSF looking at 580 patients.
Why do we care?
Cancer treatments are getting more aggressive, with more patients getting radiated even with a total mastectomy. Some of these patients are receiving the radiation before their mastectomy as well. Particularly out here in the Bay Area, many of my patients are too thin to do reconstruction with autologous tissue (ie using your belly fat to make a breast like we do in the TRAM surgeries), so implant reconstruction is a mainstay of reconstruction.
Doing total skin sparing mastectomy usually involves keeping the nipple areola complex. This enhances the reconstruction, as you no longer need to create a nipple and areola, but the worry is what happens to this area in radiated patients.
What did they find?
- Any radiation increased the rate of infection requiring antibiotics
- Any radiation caused increased risk of expander and implant loss
- The patients who had radiaiton prior to skin sparing mastectomy had a higher risk of wound breakdown.
- All groups had similar rates of nipple areola necrosis (loss)
Conclusions?
They conclude that radiation before or after mastectomy increases complication risks. They found the increased risk acceptable. The nipple areola changes were similar to those who did not get radiation. They conclude preserving the nipple areola complex is safe in women who have radiation as part of their breast cancer treatment.