Radiation isn’t given routinely after mastectomy, but it is recommended when the cancer:
- is larger than 5 cm (about 2 inches)
- has spread to four or more lymph nodes (called positive nodes)
- has positive margins (cancer is found in the rim of tissue around the cancer that is also removed)
- has spread to the skin
Many women who have mastectomy decide to have breast reconstruction — rebuilding the breast with tissue from your own body, called autologous reconstruction, or by using an implant.
We know that radiation therapy given after reconstruction surgery can increase the risk of a scar tissue capsule forming around an implant, called capsular contraction. But until now, no research had looked at the issue.
A study suggests that radiation after implant reconstruction seems to cause more complications than radiation given after autologous reconstruction.
The research, “Impact of radiotherapy on complications and patient-reported satisfaction with breast reconstruction: Findings from the prospective multicenter MROC study,” was presented on Dec. 8, 2016 at the 2016 San Antonio Breast Cancer Symposium.
In the study, called the Mastectomy Reconstruction Outcomes Consortium (MROC) study, the researchers looked at medical data and collected patient reports on reconstruction outcomes from 2,014 women who had mastectomy and breast reconstruction:
- 553 women had radiation
- 1,461 women didn’t have radiation
- about 38% of the women who had radiation had autologous reconstruction and 62% had implant reconstruction
- about 25% of the women who didn’t have radiation had autologous reconstruction and 75% had implant reconstruction
Overall, 1 year after radiation was completed:
- 28.8% of women who had radiation had at least one complication
- 22.3% of women who didn’t have radiation had at least one complication
Two years after radiation was complete:
- 34.1% of women who had radiation had at least one complication
- 22.5% of women who didn’t have radiation had at least one complication
The researchers then looked to see if there were differences by the type of reconstruction.
Two years after radiation treatment was completed:
- about 39% of women who had radiation after implant reconstruction had at least one complication
- 26% of women who had radiation after autologous reconstruction had at least one complication
Overall, radiation was linked to more than doubling the risk of complications in women who had implant reconstruction, but was not associated with a higher risk of complications in women who had autologous reconstruction.
Complications included infection at the surgery site, hematoma (collection of blood outside blood vessels), capsular contraction, and other problems.
When the researchers looked at how the women rated their satisfaction with their reconstruction results, they found that among women with implant reconstruction, those who were treated with radiation were less satisfied than women who didn’t receive radiation. There were no differences in satisfaction among radiated and non-radiated women who received autologous reconstruction.
"Although women must still weigh multiple factors, including the differences in operative time and rehabilitation required for different approaches, when selecting their preferred type of reconstruction, those who plan to receive post-mastectomy radiation therapy should be informed of the substantial and significant impact of radiotherapy observed in the current study among patients who received implant reconstruction," said Reshma Jagsi, M.D., professor and deputy chair of radiation oncology at the University of Michigan and lead author of the study.
"Conversely, those who plan to pursue autologous reconstruction and are debating whether or not to receive radiotherapy may derive some reassurance from the current study findings that outcomes among patients receiving autologous reconstruction did not appear substantially worse than those of unirradiated patients by two years," she added.
"If you know you’re likely going to need radiation after all your treatment is done — if you have chemo, surgery — then, if it’s possible, autologous reconstruction is likely to better tolerate the effects of radiation than an implant reconstruction," said Marisa Weiss, M.D., Breastcancer.org founder and chief medical officer who is also a radiation oncologist. “But if you can’t have autologous reconstruction for any number of reasons — maybe you don’t have enough tissue or maybe you have medical issues, or maybe you just don’t want to have an extended long surgery — whatever the reasons are, just be aware that radiation and implant reconstruction don’t get along quite as well.
"Still, most women who had mastectomy, implant reconstruction, and radiation had a good outcome. If you work with an experienced team, they can maximize the chance that you will have a good outcome," she continued.
"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 you get is fairly close to your original size. Because when you go to a much bigger size — for example, going to a DD when you 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. It’s a good idea to work closely with a team that’s expert in the area so 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."
If you know you’ll be having radiation after mastectomy and are considering your breast reconstruction options, you might want to talk to both your radiation oncologist and your plastic surgeon about this study. There are advantages and disadvantages to both autologous and implant reconstruction and it makes sense to talk about the risks and benefits of each type of surgery so you can figure out what’s right for your unique situation. It can also be helpful to talk to other women who have had the various types of reconstruction you’re considering, to hear about their decision-making processes, their recoveries, and their satisfaction with the results.
For more information, visit the Breastcancer.org Breast Reconstruction pages.
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