Radiotherapy Treatment

Radiotherapy treatment has been used for many years to treat breast cancer and is often a part of the therapeutic strategy if you have multiple positive lymph nodes, or a local recurrence and would like breast conservation surgery rather than a full mastectomy.

How Does Radiotherapy Work?

Radiation works by acting directly on the nucleus of the cell in order to damage it and prevent further cancerous growth. Unfortunately radiation does not discriminate between your healthy cells and the cancer cells so it can also damage the surrounding tissue. In particular, radiation can adversely affect the blood supply to normal skin which can lead to complications after your surgery. Your risk of infection, delayed healing, fat necrosis, and scarring are increased, and wound breakdown with the necessity for additional surgery due to capsular contracture or extrusion becoming more likely.

What Problems Can Arise?

Despite its benefits for treating breast cancer, radiotherapy can cause problems when it comes to your breast reconstruction. Talking to your surgeon and oncologist about your treatment options and devising a treatment plan is important in ensuring that risks are minimised if you are undergoing radiotherapy.

The timing of surgery may differ from that of another patient who is not having radiotherapy treatment. Delaying reconstruction until completion of radiotherapy and a rest period may be the most sensible option. A positive satisfactory ascetic outcome is still possible with careful planning.

Radiotherapy for More Progressed Cancer

If you have advanced disease with more than four positive lymph nodes then radiotherapy is extremely likely to be part of your treatment plan. If you have one to three positive lymph nodes and a large tumour then a mastectomy followed by radiotherapy is likely. In this case your oncologist and surgeon will usually advise immediate reconstruction during the same procedure as your mastectomy in order to reduce the potentially detrimental effects of radiotherapy on surgery you have after the treatment.

How is Breast Reconstruction Affected?

On occasion the necessity for radiotherapy cannot be fully determined prior to your mastectomy as the extent of the pathology is often confirmed after examining the tissue samples taken during the mastectomy itself. If you have a tissue expander in place to stretch the skin of your breast in order to insert a permanent implant then the need for radiotherapy as ascertained by the tissue samples taken can affect the next step in your breast reconstruction.

It may be that your skin recovers sufficiently from the radiotherapy to allow for the placement of a permanent implant. In some cases it may be necessary to perform a latissimus dorsi flap or other autologous procedure to give optimal results. Fat transfer may help with implant bases reconstruction in respect of this side effect. Your surgeon and breast care nurse will advise you regarding this.