Implant-based breast reconstruction is the most commonly performed method of reconstruction in the United States today. While the procedure can be performed in one surgery (known as ‘direct to implant’), most women have a 2-stage approach beginning with tissue expanders. These are replaced with a permanent implant a few months later at a second surgery (stage 2)
Implants are a good option for many women but may not be the best choice for some patients. In particular, patients needing radiation therapy as part of their breast cancer treatment should know that radiation increases the risk of complications after reconstruction with implants. Common complications include infection, capsular contracture (breast hardening), asymmetry, seroma, pain, and implant rupture. In many cases, additional surgery is required to address the complication.
Implants often need to be removed
A recent study published in The Breast Journal found that 44% of women with locally advanced breast cancer who had implant reconstruction needed unplanned implant removal when radiation therapy was part of their treatment plan.
The study followed 52 patients who had mastectomy, implant-based breast reconstruction, and radiation therapy from 2010 to 2017. 44% of the patients in the study had stage III disease, 77% were estrogen receptor positive, and 75% were HER2 positive.
Patients were followed for just over 3 years following surgery and treatment. 44% of patients underwent an unplanned implant removal. The average time between treatment and implant removal was only 5 months. In this study, implant removal was required before starting radiation in 17% of the patients, and after radiation was completed in 27% of the patients.
Reasons for implant removal before radiation began were infection (44%), wound breakdown (33%), hematoma (11%), and concern about planned radiation (11%). Reasons for implant removal after radiation included significant breast asymmetry (57%), infection (21%), a deflated expander (14%), and seroma (7%). Some women had bilateral mastectomy and reconstruction – most of the complications in these cases occurred in the breast that underwent radiation therapy.
This study is yet another example of why it is important for patients to be fully informed of the potential risks associated with surgery they choose. Fully-informed patients also tend to have more realistic expectations, which in turn can also improve recovery and the overall satisfaction with the final outcome.
You have other options!
Fortunately, implants are not the only reconstructive option and most women are candidates for alternative procedures. These include other types of breast reconstruction using the patient’s own tissue (known as ‘flaps’), and aesthetic flat closure (going flat).
If you are facing a similar situation and would like to learn more about your options, the Breast Advocate app can help – download it today!
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.