Can You Prevent Radiation Damage to Breast Tissue? Two Things That Help

Radiation is an important part of breast cancer treatment for a lot of patients, after a mastectomy or after a lumpectomy. It also changes the tissue it treats. Over time, radiated tissue can develop fibrosis (it becomes firm and tight) and it shrinks a little.

So are there ways to prevent that damage, or improve it once it's there? The answer is absolutely yes. I have two that are my absolute favorites.

Hyperbaric oxygen therapy (HBOT) means breathing oxygen in a pressurized chamber over a series of sessions. It can be very helpful with some of the fibrosis and shrinkage you see after radiation.

There's good evidence behind it. In a 2024 randomized trial published in JAMA Oncology, women with late side effects at least a year after breast radiation who were offered HBOT were significantly less likely to have moderate or severe fibrosis than those who weren't (33% versus 51%). It is a commitment, though: the trial used 30 to 40 sessions over six to eight weeks, and the time involved was the main reason women turned it down.

For my radiated patients who are having surgery, I also use HBOT around the operation, usually about two weeks before and at least two weeks after, because radiated tissue has a harder time healing. HBOT may be covered by insurance if you've had radiation, so it's worth asking. (More on how I use it in treating capsular contracture after radiation.)

The second thing that can be very helpful is fat grafting. We take healthy fat from elsewhere on your body with liposuction and move it into the area that's been radiated.

Radiation shrinks things a little, and fat grafting adds a little back. It's a graft, like a skin graft, which is why how fat grafting actually works matters for what to expect: not all of the fat survives, and some patients do more than one round.

Timing matters too. We usually let you recover from radiation for about six months before fat grafting.

Both are wonderful options after either a mastectomy or a lumpectomy, if you've had radiation. You don't need to have had reconstruction for them to help.

If you have had reconstruction, radiation brings a few specific issues, and I've written about each one:

• Implant reconstruction when you need radiation, including what you can do to protect your skin during radiation
• Why the radiated side often ends up firmer and higher, and how to even things out
• Capsular contracture after radiation, and why it doesn't automatically mean the implant has to come out

Radiation can leave breast tissue firmer and smaller, but you're not stuck with it. Hyperbaric oxygen therapy can help with some of the fibrosis and shrinkage, and fat grafting brings healthy tissue back into the radiated area to improve its quality. Both can help after a mastectomy or a lumpectomy, and your plan should be tailored to you. Ask your reconstruction and radiation team which makes sense for you, and when.