Breast Reconstruction After Radiation: Surgical Options

Southwest Breast & Aesthetics

Implant vs. Autologous Breast Reconstruction 

Our goal for breast reconstruction in Phoenix is to restore the breast and achieve symmetry. Breast implants after radiation have up to a 29% failure rate, but equally as important, even if successful, may not lead to a satisfying or symmetric result. In some cases the tissues may be minimally affected by radiation, and an implant can be considered, however tissue-based reconstruction is a much better option because new healthy tissue is transplanted in the previously radiated field to reconstruct the breast. The flap can also be used to help replace any scarred or damaged skin so that the breast will feel soft and can be as symmetric as possible with the non-irradiated side. 

There are several different kinds of autologous or “flap” surgeries that can be performed. The method used depends on your anatomy and which one your Phoenix breast surgeon feels will provide the best results. Here are just a few examples of different types of flap reconstruction methods.

DIEP Flap Breast Reconstruction

This method of reconstruction is a free flap method and takes skin, fat, and blood vessels from the lower belly area to reconstruct the breast. The DIEP flap method does not remove any muscle from the stomach area for the transplant, meaning patients can avoid loss of core strength in the area.

Along with removing the fat, a tummy tuck can be performed to improve the appearance of the abdominal area. Since the blood vessels are separated from the donor area in this method, they will need to be reconnected via microsurgery. This is a common and typically very successful procedure, however, microsurgery requires specific experience and skill, so you will want to ensure your surgeon is well-qualified.

PAP FLAP Breast Reconstruction

The PAP flap method is sometimes used when there is a lack of tissue in other common areas, such as after a tummy tuck. This is a better option for those needing to reconstruct smaller breasts since there is limited tissue in the area. However, some patients' anatomy may make this a more favorable site than others. After this tissue is removed and the area is closed, you will have what looks like an inner thigh lift.

SGAP Flap Breast Reconstruction

The SGAP technique is similar to the DIEP method, but the flap is taken from the upper buttock area or hips. Only fat, skin, and blood vessels are moved; no muscle is transferred, which typically allows for easier healing and keeps muscle tone and strength intact in the area where the flap is taken from. The SGAP is a good option for patients who need reconstruction for both breasts since the donor tissue can be taken from the hips or buttocks on both sides. 

Now What? 

Timing is a very important factor in choosing how to proceed. For patients with active cancer who have a high likelihood of future radiation (i.e., positive lymph nodes, tumor larger than 5 cm, chest wall involvement) we choose to place a tissue expander at the time of mastectomy or avoid any reconstruction until 3-6 months after the end of radiation. For patients with a past history of radiation who have a recurrence, it is unusual to need future radiation in the same location. A flap can be placed when the acute inflammation has resolved. The same is true for patients who had implant-based reconstruction or a latissimus flap after radiation. 

To answer every one of these questions, it is crucial to have a consultation with highly experienced and qualified plastic surgeons like the team at Southwest Breast. We are specialists and can offer unmatched skill and compassion for your breast reconstructive surgery.