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Can radiation damage affect reconstruction?

Page last modified on: October 16, 2008

Question from DellaV: Because I am small, I have to have latissimus flap surgery. However, my plastic surgeon says my radiation treatment was very aggressive and my muscle and tissue is too damaged right now for the surgery. Can radiation cause this much damage and potentially create a situation where reconstruction would not give acceptable results?: Answers —Jennifer Sabol, M.D., F.A.C.S.: If Dr. Serletti doesn't mind I'd answer the portion of radiation therapy. Every patient responds to radiation differently and there are some subgroups of patients, specifically those that may have an underlying collagen vascular disorder that may develop profound fibrosis, or thickening, of the skin from a radiation treatment. As a general rule, it is best to allow this radiated skin to heal for at least 9 to 12 months prior to attempting some type of reconstruction, with the ultimate goal being the best cosmetic result possible. Maybe Dr. Serletti can comment more about the timing of radiation and reconstruction.; Joseph Serletti, M.D., F.A.C.S.: In general, the earliest that we would consider something to a radiated mastectomy site would be three months after the radiation. We do see some patients whose tissues have a more profound reaction to the radiation. In that type of patient, we usually wait, as Dr. Sabol has just spoken about, 9 to 12 months. Usually, at 9 to 12 months, in almost any patient, even someone who does not have enough abdominal tissue, we can usually do a satisfactory reconstruction using a latissimus flap. My sense here is that your plastic surgeon is concerned about the reaction that your chest's soft tissue has had to the radiation, and wants to appropriately wait for that to settle down before moving ahead with reconstruction. It would be a very unusual situation where no reconstruction could be offered in such a setting.

On Wednesday, May 16, 2007, the Ask-the-Expert Online Conference was called Reconstruction Updates. Joseph Serletti, M.D. and moderator Jennifer Sabol, M.D. answered your questions about breast reconstruction.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Joseph M. Serletti, M.D., F.A.C.S. is professor of surgery and chief of the Division of Plastic Surgery at the University of Pennsylvania. He is a pioneer in the field of free flap autologous breast reconstruction.

Jennifer Sabol, M.D., F.A.C.S. is a breast surgeon who directs the newly developed Breast Care Center at Lankenau Hospital in Wynnewood, Pa. Among her many interests, Dr. Sabol spearheads several research initiatives to advance the care for women with breast cancer and improve methods of breast cancer detection and treatment.