Breast cancer patients who receive radiation therapy after mastectomy may have more problems with breast implants, but implant-based breast reconstruction after radiation therapy is still successful in most cases.

These are the main findings of a new review study in the October issue of Plastic and Reconstructive Surgery.

Steven J. Kronowitz, MD, of the University of Texas MD Anderson Cancer Center in Houston, analyzed data from 29 studies on the use of implants among breast cancer patients receiving radiation therapy to help reduce their risk of recurrence.

Generally speaking, breast reconstruction results after radiation therapy tend to be better when the patient’s autologous tissue is used.  However, in some situations implants may be the preferred option for reconstruction, or the only choice.

In one study included in the review, the risk of major complications was about 45 percent for women receiving implants with radiation therapy, compared to 24 percent among those not exposed to radiation therapy.  Complications were more common when radiation was given before versus after implant-based reconstruction: 64 versus 58 percent, respectively.

Among women undergoing implant-based reconstruction, patient satisfaction scores were lower for those receiving radiation therapy. Specifically, radiation-related skin damage predicted higher complication rates and poorer aesthetic outcomes after implant-based reconstruction.   

The new study also suggested methods and techniques that may help improve patient satisfaction with the cosmetic results. For example, outcomes appear better with two-stage reconstruction, where the implant is placed after radiation, rather than immediately after mastectomy. Fat grafting to the breast may also help improve upon the results.