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Delayed Breast Reconstruction Following Radiation Therapy

Often when patients come to discuss breast reconstruction options in consultation, the choices to be made regarding reconstruction can often be more confusing to patients than the oncologic surgery itself.

In our initial breast reconstruction discussion, patients understand that they can either decide to have breast reconstruction or to not have breast reconstruction. More often, patients choose to undergo breast reconstruction.

We next discuss that they can initiate their breast reconstruction process immediately, that is in the same operation as their mastectomy or they may undergo their reconstructive process after they have completed their mastectomy.

In the photograph above, the patient underwent mastectomy followed by radiation therapy. Not all patients who undergo mastectomy will require radiation therapy.

Radiation is often a necessary adjunct to breast cancer treatment. Radiation can affect different types of tissue differently and can act very differently among patients. Some patients who have undergone radiation therapy may be able to have a tissue expander or implant reconstruction based on the quality of the skin and soft tissues that have been irradiated. In other patients, the skin has undergone significant radiation changes and reconstructive surgeon may find an autologous tissue reconstruction to be a more viable option.

Autologous tissue reconstructions involving using the patient’s own body tissue to reconstruct the breast either partially or in its entirety.

When a significant amount of tissue has been radiated the reconstructive surgeon will often remove the skin that has been damaged by radiation and replace this with skin and fat from another area on the patient’s body.

The photograph shown above demonstrates a delay procedure- TRAM flap reconstruction. The next stage of the reconstruction, will be nipple areola complex reconstruction.