Today, many women receive radiation therapy Radiation Therapy May Impact Results of Breast Reconstruction (dateline August 20, 2000) | Breast Health News | Imaginis - The Women's Health & Wellness Resource Network

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Radiation Therapy May Impact Results of Breast Reconstruction (dateline August 20, 2000)

Today, many women receive radiation therapy after a mastectomy (surgical removal of the breast) to help destroy any remaining cancer cells and reduce the risk that breast cancer will return ( recur). Now researchers from Georgetown University are investigating the effects of radiation therapy on women who choose to have breast reconstruction . The results of their study show that post-mastectomy radiation can significant impact breast reconstruction, often causing more complications and leading to less successful cosmetic results.

The number of breast reconstruction patients who have received radiation therapy is on the rise.  In a 1985 report, only one of 185 women who had breast reconstruction had received radiation therapy in addition to surgery.  In the Georgetown University study, 19 of 40 breast reconstruction patients had received radiation therapy from 1990 to 1997.

In the Georgetown study, researchers monitored 40 patients who underwent two-stage saline-filled implant breast reconstruction in addition to radiation therapy.  The first step of this type of reconstruction involves the insertion of a tissue expander to stretch the breast skin so that an implant may be placed.   After the skin has been sufficiently stretched, the expander is removed and a saline breast implant is permanently inserted into the breast area. 

These 40 women were compared to a control group that consisted of another 40 women who had two-stage implant breast reconstruction but did not have radiation therapy.  According to the results of the study, 47% of the women who underwent radiation and breast reconstruction eventually needed to undergo additional surgery to remove the implant and add a tissue flap (tissue from the abdomen, thigh, or back) to the breast area.

The women who underwent radiation therapy also experienced other complications, including capsular contracture , a condition in which the scar around the implant begins to tighten and squeezes down on the soft implant, causing the breast to feel hard.  According to researcher Cynthia Welsh, MD of Georgetown University, women who have radiation therapy may be predisposed to developing painful scar tissue.

The extent of damage to the breast from radiation therapy depends on a number of factors, and many women do not experience any significant problems from radiation.  The dose and distribution of radiation as well as the use of a bolus (a tissue-like material used to increase the radiation dose at the surface of the skin), can influence the complications that women experience from radiation.

Temporary side effects of radiation therapy may include:

  • Fatigue
  • Neutropenia (reduction in white blood cells)
  • Breast swelling or tenderness
  • Feeling of heaviness in the breast
  • Sunburn-like appearance of the breast skin
  • Loss of appetite

According to the researchers, patients who receive less radiation to the skin typically have more positive results with breast reconstruction.   Increased or aggressive radiation can cause more complications with breast reconstruction and can lead to less satisfying cosmetic results.  The researchers did note that breast reconstruction using a tissue flap can improve the results of breast reconstruction in women who have received radiation therapy.  Also, two-stage breast reconstruction with a tissue expander and saline implants is often more successful than one-stage reconstruction with silicone gel-filled breast implants. 

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