Does radiation therapy increase the risk of failure in immediate breast reconstruction?

The study examined whether radiation therapy increased the risk of implant failure in women undergoing immediate breast reconstruction following mastectomy.

Treatment for breast cancer generally includes a combination of surgery to remove either the tumor or the full breast (mastectomy), radiation, and chemotherapy. Patients undergoing mastectomy have the option of having an immediate breast reconstruction with implants. Radiation therapy following a mastectomy has been shown to reduce the risk of recurrence (return of the disease) by 17%, and is therefore being offered more frequently.

However, radiation therapy can lead to the formation of scar tissue, or fibrosis, which could interfere with the implants used in breast reconstruction, leading to the need for either removal of the implants or surgery to repair the damage. The extent to which radiation therapy can increase the risk of implant failure is not yet clear. The current study examined how radiation therapy, both prior to surgery and postoperatively, affected patients with implant-based immediate breast reconstruction.

This study followed 725 patients who underwent implant-based immediate breast reconstruction following mastectomy. 64 patients had undergone prior radiation therapy for previous breast or other cancer; 304 were given postoperative radiation therapy; and 357 did not receive any radiation therapy.  The outcomes measured were frequency of implant failure, defined as the necessary removal of the implant, and the necessity of an unplanned second surgery to repair damage. Patients were followed for an average of 43 months, at which time they were asked to complete a questionnaire evaluating their satisfaction with the procedure.

Implant failure was experienced by 6% of the patients who did not receive radiation therapy, 25% of those who received prior radiation therapy, and 15% of patients who received postoperative radiation therapy.

Further, unplanned surgery was needed in 44% of the patients who did not receive radiation therapy, 66% of patients who received prior radiation therapy, and 59% of patients who received postoperative radiation therapy.

Despite the high percentage of patients needing further surgery, the questionnaire responses indicated that patients were generally positive about immediate breast reconstruction, though radiation therapy significantly decreased the number of women who would encourage other women to undergo the treatment. 86% of women who did not have any radiation therapy would recommended the procedure, compared to 68.6% of women who had prior and 77.7% who had postoperative radiation therapy.

This study concluded that there is a negative impact of radiation therapy on the success of immediate breast reconstruction, particularly in patients with prior radiation therapy. However, high patient satisfaction suggests that the benefits may outweigh the risks for many women.

If you are considering implant-based immediate breast reconstruction, discuss with your physician the possible effects of radiation therapy. 

If you are considering implant-based immediate breast reconstruction, discuss with your physician the possible effects of radiation therapy.