How does radiation affect flap breast reconstruction?

Updated: Jan 10, 2020
  • Author: Mark F Deutsch, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

Patients who receive either preoperative or postoperative radiation and undergo reconstruction with implants are more likely to develop capsular contracture than those who do not receive irradiation. [8, 9] While a latissimus flap placed over the implant may alleviate some of the effects of radiation on the implant, it also can provide needed skin in patients with delayed reconstructions or large skin resections. The surgeon has more options for revising a breast reconstructed with an implant and a latissimus flap than one with an implant alone, and the additional procedure requiring replacement of the expander for a permanent implant is avoided.

When placed behind a latissimus flap, the implant can be round or anatomic depending upon the desired shape of the breast. Measurements of the base diameter of the breast are important in planning reconstruction. The diameter of the implant should not exceed the diameter of the breast pocket. If the desired implant is too wide for the breast pocket, consider a smaller implant with a contralateral reduction or a different method of reconstruction.

A literature review by Yun et al indicated that although there has been an increase in the use of implant-based breast reconstruction techniques in the setting of postmastectomy radiation therapy (PMRT), quality of life and sensory recovery are better in patients who undergo autologous reconstruction with PMRT. In addition, DIEP flaps may be a superior option to TRAM flaps for reconstruction in the context of PMRT. [10]

An advantage to autologous reconstruction with regard to PMRT was also seen in a study by Reinders et al. Of 109 patients who underwent breast reconstruction immediately after skin-sparing mastectomy, the investigators found that 17 of the 80 patients in whom implant-based reconstruction was performed (21%) suffered reconstruction failure following PMRT, while no such failure occurred after PMRT in the 29 patients who underwent autologous reconstruction. [11]


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