What’s the big deal?
The short answer it that if you need radiotherapy for your breast cancer treatment it changes the options that you have for reconstruction.
It is the single biggest determinant regarding choice of reconstruction. Some plastic surgeons will still offer you an implant reconstruction because it is relatively easier however the risk of getting a capsular contracture is much higher in a radiotherapied field (in the order of 70% at 10 years). This will then require multiple future operations to remove the capsule and replace the implant.
Implants should be seen to be a less durable long term solution. In order to try and lower the rate of capsular contracture, most breast reconstructive plastic surgeons will offer additional cover to the implant in the form of the latissimus dorsi flap from the back. The theory behind this is to give new cover over the top of the implant with non-irradiated tissue and whilst there is no firm evidence that this reduces capsular contracture rates, the theory at least is sound. The downside is that the implant is still in contact with the chest wall which has also been irradiated.
Implant based reconstruction has a much higher rate of capsular contracture in a radiotherapied field.
The gold standard reconstruction for patients that have had radiotherapy is to use your own tissue known as autologous reconstruction. By far and away the tissue that is used the most is the skin and fat from the abdominal tissue below the navel (DIEP, SIEP or TRAM flaps). This is the same tissue which is removed in a tummy tuck and the scar is identical. There are various ways of taking this tissue but most of the time it requires microsurgery and is a much larger operation. If you don’t have enough abdominal fat then it is possible to transfer tissue from other regions such as the inner thigh (TUG flap) or the buttock (IGAP, SGAP).
This opinion piece was brought to you by Dr Damien Grinsell.