Can You Have Implant Breast Reconstruction If You Need Radiation?

Radiation is an adjunctive therapy we sometimes use to treat breast cancer. Often, having a mastectomy means a patient doesn't need radiation, but that's not always the case. Some patients still do. (Newer research suggests some patients may not need it at all.)

Traditionally, when patients were going to have radiation, we would tell them they couldn't have a breast reconstruction using implants.

The main reason was the fear of capsular contracture, where the scar tissue around an implant tightens and hardens. Some of the older studies showed very high rates of contracture in patients who had radiation.

Radiation does still raise the risk of contracture, and it can be hard on implants, so it's worth planning for. But it isn't the automatic deal-breaker it used to be, and if a contracture does develop, it can still be treated without giving up the implant: here's how I treat a contracture after radiation.

In general, what I see when my patients have radiation:

• The radiated side feels a touch more firm (reconstruction implants feel firmer in general, and radiation adds to that)
• It often sits a little higher than the other side (why, and what helps)

We can improve the feel of that tissue with fat grafting later. We usually let you recover from radiation for about six months, then come back and bring some healthy tissue into the area with fat grafting.

There are also things we can do during radiation to try to minimize stiffening of the tissue.

I recommend topical antioxidants on the skin to help protect it during radiation. A lot of radiation doctors recommend vitamin E capsules. They just don't work very well, and there are better antioxidants on the market. I usually recommend my patients use antioxidant products made for the face on the skin of the chest during radiation.

There's also a medication that can help minimize fibrosis, the firm tissue that forms from radiation. Ask your radiation and reconstruction team whether it's right for you.

Radiation does raise the risk of contracture, so go in with a plan. But implant-based reconstruction is still an option for patients who need radiation, and I think it should be an option for everyone having breast reconstruction, with or without radiation. More on reconstruction and radiation and revising a reconstruction after radiation.