Radiation Effects on Reconstruction -- Heard in the Halls: Voices From the 2016 San Antonio Breast Cancer Symposium
Marisa Weiss, M.D.
December 10, 2016

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Breastcancer.org Chief Medical Officer and Founder Marisa Weiss, M.D. talks how radiation therapy can affect different types of breast reconstruction.

Running time: 4:28

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Dr. Marisa Weiss: My name is Dr. Marisa Weiss. I’m chief medical officer of Breastcancer.org. Many women who are diagnosed with breast cancer require multiple different forms of treatment in order to get rid of the different kinds of cells that can live in one cancer, so there are quite a number of women who may have had mastectomy and require radiation after mastectomy to the area where the breast used to be or the adjacent lymph nodes. And many of those women who’ve had mastectomy also have chosen reconstruction to try to reconstruct the breast. And you can reconstruct the breast by borrowing tissue from another part of the body, or you can recreate the mound of the breast using an expander-to-implant or just an implant, depending on the technique.

So we heard a study here at San Antonio looking at the results of reconstruction in women who’ve had mastectomy and also had radiation. They compared women who had tissue reconstruction versus women who had implant reconstruction to see which form of reconstruction is most compatible with the best outcome. What they found was that women who had tissue reconstruction had a better outcome, that the reconstruction tolerated the radiation better, it looked better and it was more satisfactory to the patient, compared to implant reconstruction where there were more complications when mastectomy with implant reconstruction was followed with radiation.

So if you’re looking at having to have radiation after mastectomy, and you know that right up front before everything starts because they know enough about your situation to know you’re likely going to need radiation after all your treatment is done — if you have chemo, surgery — then, if it’s possible, a tissue reconstruction is likely to better tolerate the effects of radiation than an implant reconstruction.

But if you can’t have a tissue reconstruction for a number of reasons, maybe you don’t have enough tissue to put up there to make new breasts out of, or maybe you have medical issues, or maybe you just don’t want to have an extended long surgery, or you have to go back to work, whatever the reasons are, just be aware that radiation and implant reconstruction don’t get along quite as well. But still, most women had a good outcome who had mastectomy, implant reconstruction, and radiation. Most women did have a good outcome, and if you work with an experienced team, they can maximize the chance that you will have a good outcome.

And one thing that I recommend as a breast radiation oncologist who deals with this issue all the time is to make sure that the implant that you get is fairly close to your original size. Because when you go to a much bigger size — for example, many women might choose to get, like, a DD when maybe they were an A cup before — you’re really asking the skin envelope of the prior breast to take on a much bigger job description than it ever had, and that skin has been through a lot already. It’s lost a lot of its blood supply with mastectomy, it’s been stretched, it’s maybe been subjected to chemo, it’s not the happiest camper on the block. So it’s best to be gentle and to use a size that is most compatible with and similar to your original size, so that you don’t push your tissues beyond their natural comfort zone. And so I would just say work closely with a team that’s expert in the area so that you can get a reconstruction that is pleasing to you, it makes you feel good about yourself, and you can minimize the amount of side effects.

Now, women who did have problems after implant reconstruction and radiation were able to improve it over time with various tinkering and tweaking and little procedures here and there, so it’s not as if you’re stuck with a result that you’re not happy with. I would just say to really go to Breastcancer.org because we have a lot of resources on reconstruction, and in the Community there are a lot of women who’ve been there, done that, and have a lot of personal tips that can be really helpful as well.

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