As a part of Breast Cancer Awareness month, here is some new news to help educate patients about reconstructive procedures after treatment. Patients who have undergone radiation after surgery for breast cancer may be at risk for more complications with breast reconstruction procedures using implants than by using their own fat in breast reconstruction.
However, plastic surgeon Steven J. Kronowitz, MD, who is also a member of the American Society of Plastic Surgeons, reports of high satisfaction rates among women who have had breast reconstruction using implants even though there can be a high rate of complications. Dr. Kronowitz is from the University of Texas MD Anderson Cancer Center in Houston, Texas.
Nineteen articles that were published in the journal Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons, noted that the general trend of increased risk of complications and unfavorable aesthetic results after radiation therapy.
A study made in the Department of Breast Surgery in Mater Misericordiae University Hospital in Dublin, Ireland reports of the same morbid outcomes on breast reconstruction secondary to the use of post mastectomy radiation therapy or PMRT.
One study identifies a 45% complication rate for patients who received implants with PMRT versus 24% of those who didn’t receive radiation. When it comes to timing, patients who had radiation prior to breast reconstruction with implants had a 64% complication rate as opposed to 58% for patients who had radiation after breast reconstruction with implants. On the other hand, one publication reports of women who had radiation after implant-based reconstruction to have higher chances of undergoing corrective surgery. However, Dr. Kronowitz says that patients who have undergone breast reconstruction with implantation choose to retain the implants amidst the complications.
Other techniques, as also reported by Dr. Kronowitz analysis, may help improve outcomes for these sets of patients. This includes the addition of the patient’s own fat, known as ‘autologous fat transfer’ to come up with better results. This fat transfer, sometimes also called ‘breast fat grafting’ was first used for reconstruction of scars in 1893. Autologous fat is identified as an ideal agent because of its ease of use, for being non-toxic, and for being biologically compatible with the patient. However, its rise in popularity as a gold standard technique is plagued by issues regarding its safety and efficacy. Transplanted fat has an unpredictable re-absorption profile. Also the risk of development of fat necrosis, which may lead to liponecrotic cysts and microcalcifications, can be mistaken for breast carcinoma. However, it will not be for long before expert find ways around these setbacks.
Breast reconstruction surgery comes in different types. This “one-stage immediate breast reconstruction” is a procedure where reconstruction is done simultaneously when cancerous breast lesion is removed. This involves the skills of a general surgeon in the removal of the tumor after which a plastic surgeon puts a breast implant in place, most commonly in the form of a saline implant. The “two-stage reconstruction,” on the other hand, is said to be the procedure of choice for patients contemplating the use of an implant. Otherwise known as delayed-immediate reconstruction surgery, this method is favorable as it allows for flexibility of timing if in case a biopsy result suggests need of radiation which would advisably delay reconstruction.
Radiation therapy has long been known to be part of the treatment regimen for breast conservation therapy. However, the use PMRT has long been debated. Although it has been established to reduce the risk of local failure of primary breast carcinoma, the benefit of PMRT in overall survival has only been recently documented.