While many women prefer to have breast reconstruction at the same time as mastectomy, some doctors recommend against it because they fear it might interfere with further treatment. Radiation therapy, which can take several months, is often given after mastectomy to get rid of any remaining cancer cells.
After breast removal surgery, "a lot of institutions want to do radiation therapy first, and some may recommend against breast reconstruction altogether," says Penny R. Anderson, MD, a radiation oncologist at Fox Chase Cancer Center in Philadelphia.
The reason, she says, is some doctors fear that complications from surgery -- such as scarring of the new breast or infection -- may delay completion of radiation therapy.
But Anderson's new study, reported here Wednesday at the annual meeting of the American Society for Therapeutic Radiology and Oncology, suggests such worries may be unfounded.
She says that her team at Fox Chase was not seeing undue complications when breast reconstruction was done prior to radiation therapy.
"Women Feel Better"
Breast reconstruction surgery involves creating a breast -- using either the patient's own body tissue or the placement of a breast implant -- that comes as close as possible to the appearance of a natural breast.
Having the breast replaced as soon as possible after mastectomy has a host of advantages, both psychological and cosmetic, she says. "Women feel better about themselves."
Thanks to newer surgical techniques, the results are better than ever, Anderson says. "You can look at a naked woman [who had the surgery] and never even realize her breasts aren't real."
The new study involved 85 breast cancer patients who underwent mastectomy, breast reconstruction, and postoperative radiation therapy. Some of the women had the breast reconstruction procedure known as a TRAM flap, which involves taking an area of fat, skin, and muscle from the abdomen and swinging it up and under the skin of the chest wall to create a breast shape. Other women opted for breast implants as a form of breast reconstruction.
Overall, 70 women had radiation therapy after breast reconstruction -- receiving radiation therapy an average of seven months after the breast reconstruction surgery. The other 15 women received the radiation treatment before their breast reconstruction.
The timing of radiation therapy -- before or after breast reconstruction -- had no significant impact on the complication rates or cosmetic results, the study showed.
By five years later, none of the women who had the TRAM procedure had major complications or required corrective surgery. Also, only 5% of the women who had implants had major complications.
"We had to remove the implants in two of the women for reasons such as infection, but they could undergo the procedure again if they wanted," Anderson says.
Minor complications, such as infection or scarring, occurred in 39% of TRAM patients and 14% of those who had implants, she says.
"But all of these TRAM patients had excellent cosmetic outcomes," Anderson says. "They might have been able to feel a tiny lump of scar tissue on palpitation, but it wasn't visible to the naked eye."
Waiting May Still Be Better
But some experts still aren't convinced that immediate breast reconstruction is a good idea.
Thomas Buchholz, MD, a radiation oncologist at the University of Texas M.D. Anderson Cancer Center in Houston, who was the discussant for the presentation, said that while the study is an important one, he still thinks women are better off delaying breast reconstruction until after radiation therapy is completed.
"The issues are twofold," he tells WebMD. "Does reconstruction negatively affect the delivery of radiation, and which option gives the best cosmetic outcome?
"At M.D. Anderson, we find it advantageous to delay breast reconstruction as it allows us to deliver the radiation therapy as safely as possible," he says. The presence of a new breast or implant makes it harder to hit the target, so radiation might inadvertently damage healthy lung tissue.
Also, studies at M.D. Anderson have suggested that delayed breast reconstruction is associated with better cosmetic results, Buchholz says. "Radiation can cause the implant or rebuilt tissue to scar down. It looks like a rock, becomes contracted and distorted."
Noting that this scarring often doesn't occur until many years after treatment, he says, "Maybe the Fox Chase study had a lower rate of complications because they didn't follow the women long enough."