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07.08.2015
As a part of Breast Cancer Awareness month, here is some new news to help educate patients about reconstructive procedures after treatment.
Nineteen articles that were published in the journal Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons, noted that the general trend of increased risk of complications and unfavorable aesthetic results after radiation therapy. A study made in the Department of Breast Surgery in Mater Misericordiae University Hospital in Dublin, Ireland reports of the same morbid outcomes on breast reconstruction secondary to the use of post mastectomy radiation therapy or PMRT.
One study identifies a 45% complication rate for patients who received implants with PMRT versus 24% of those who didn’t receive radiation.
Radiation therapy has long been known to be part of the treatment regimen for breast conservation therapy.
A Breast Mastectomy is a medical procedure that involves the complete removal of the breast that has been affected by cancer. During a mastectomy, a doctor would surgically remove the entire breast along with the skin, breast tissue, areola and nipple. The complications that arise from a Breast Mastectomy can depend on several factors like the type of the mastectomy chosen for the procedure, the severity of the condition and the patient’s body constraints etc. However, here are some of the more common symptoms that you need to be wary of before opting for a mastectomy. In case of more serious types of mastectomy procedures like radical mastectomy where the entire breast and chest muscles are removed along with the connective lymph nodes under the arms, patients can experience anything from mild to stabbing pain in the chest and shoulder region afterwards.
This pain is usually experienced due to the removal of the lymph nodes and chest muscles which disrupt the normal functioning of the muscles and nerves present in the shoulders, arms and chest. The mastectomy procedure usually involves the removal of the breast tissue and the underlying skin.
The loss of these nerves would tend to cause a feeling of numbness in the skin in and around the surgical site. During a mastectomy, the doctor would cut away the breast and sever a few lymph nodes in the process to prevent the spread of the disease.
Although a certain amount of lymphedema is expected and is considered quite normal after a general mastectomy, in certain cases the complication would become too severe to handle and could last up to six weeks after a mastectomy.


There are certain risks associated with breast mastectomies that are common in other surgical procedures as well. Patients who have undergone radiation after surgery for breast cancer may be at risk for more complications with breast reconstruction procedures using implants than by using their own fat in breast reconstruction. Kronowitz, MD, who is also a member of the American Society of Plastic Surgeons, reports of high satisfaction rates among women who have had breast reconstruction using implants even though there can be a high rate of complications. When it comes to timing, patients who had radiation prior to breast reconstruction with implants had a 64% complication rate as opposed to 58% for patients who had radiation after breast reconstruction with implants. This “one-stage immediate breast reconstruction” is a procedure where reconstruction is done simultaneously when cancerous breast lesion is removed.
The surgical procedure is usually initiated for large, invasive breast cancers that are too dangerous to be treated by other forms of breast cancer treatment. In this case, even the healthy tissue present in the breast is removed to prevent the malignant cancer from spreading to other parts of the body. Some patients may also experience a ‘phantom pain’ which they feel arises in the surgical area even after the removal of the entire breast. In addition to this, doctor would usually cut a few nerves located inside and around the breast to prevent the disease from spreading. This numbness can persist for many months and could also be accompanied by shooting pains that eventually reduce to dull aches as time passes.
The severed lymph nodes would disrupt the otherwise normal flow of lymphatic fluid to and from the arms. In some cases, women who have undergone mastectomy could experience painless lymphedema for about two years after the procedure. On the other hand, one publication reports of women who had radiation after implant-based reconstruction to have higher chances of undergoing corrective surgery.
This includes the addition of the patient’s own fat, known as ‘autologous fat transfer’ to come up with better results.


This involves the skills of a general surgeon in the removal of the tumor after which a plastic surgeon puts a breast implant in place, most commonly in the form of a saline implant.
Although it has been established to reduce the risk of local failure of primary breast carcinoma, the benefit of PMRT in overall survival has only been recently documented.
Nevertheless, the numbness and pain experienced in and around the breast area after a mastectomy could be quite uncomfortable and could last up to a year in certain cases. This in turn would lead to the collection of lymphatic fluid under the arms and near the affected tissues, a condition that would cause swelling, discomfort and pain in the arms and chest area. This fat transfer, sometimes also called ‘breast fat grafting’ was first used for reconstruction of scars in 1893.
The “two-stage reconstruction,” on the other hand, is said to be the procedure of choice for patients contemplating the use of an implant. Kronowitz says that patients who have undergone breast reconstruction with implantation choose to retain the implants amidst the complications. Autologous fat is identified as an ideal agent because of its ease of use, for being non-toxic, and for being biologically compatible with the patient.
Otherwise known as delayed-immediate reconstruction surgery, this method is favorable as it allows for flexibility of timing if in case a biopsy result suggests need of radiation which would advisably delay reconstruction.
However, its rise in popularity as a gold standard technique is plagued by issues regarding its safety and efficacy. Also the risk of development of fat necrosis, which may lead to liponecrotic cysts and microcalcifications, can be mistaken for breast carcinoma.



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