Ask your doctor: Radiation and DIEP flap breast reconstruction

If I know I will have to have radiation, and I want the DIEP flap, should I have immediate or delayed breast reconstruction?

Great question! If you are anticipating radiation treatments as part of your breast cancer treatment after your mastectomy, most plastic surgeons recommend breast reconstruction be delayed until after radiation. Radiation after tissue (flap) reconstruction can create complications in the newly reconstructed breast: the reconstructed breast can shrink and become more firm. This creates obvious differences in breast symmetry requiring further surgery to correct. Radiation after implant-based reconstruction can lead to breast hardening, excessive thinning of the tissue covering the implant (making it more visible), and even implant exposure (and subsequent removal).

Immediate breast reconstruction can still be performed if post-mastectomy radiation is planned, however, a coordinated team approach involving a radiation oncologist experienced in treating breast reconstruction patients is key in decreasing the risk of complications.

Are there any other options if I want to avoid being without a breast and really desire immediate reconstruction?

If you are interested in flap breast reconstruction (using your own tissue) and are scheduled to have radiation, you may be a candidate for "delayed-immediate" reconstruction. This approach involves placing and filling a tissue expander at the time of the mastectomy, then proceeding with radiation treatments. This allows preservation of most of the breast skin (skin- or nipple-sparing mastectomy) which typically improves the final cosmetic result. After the radiation therapy is completed, the tissue expander is removed and the definitive tissue reconstruction is performed.

The PRMA surgeons do not have a specific preference on how patients receiving radiation choose to proceed. However, it is important to weigh the pros and cons of the procedure before proceeding with surgery:

Pros:

• Preserves skin envelope and takes advantage of the aesthetic benefits of a skin-sparing mastectomy.
• Emotional benefit of avoiding the experience of living without a breast.
• Keeps all options option.

Cons:

• Increased risk of complications during radiation like infection, skin breakdown and the need for removal of the expander (i.e. more surgery).
• Depending on the preference of the radiation oncologist, the tissue expander may be temporarily deflated prior to starting, and during radiation therapy. In this case, the expander is re-inflated after radiation is completed.

It is important to remember breast reconstruction is not a cookie cutter procedure. Every woman is different, and there are options available to meet the needs of every individual. If you know radiation treatments will be necessary and are interested in the DIEP flap, discuss your options with your doctor to decide what plan of action is best for you.

For more information, including a list of ASPS plastic surgeons in your community, please use our Find a Plastic Surgeon tool.

*Originally published on PRMA's blog