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Radiation before or after augmentation

Breast cancer occasionally occurs in women who have previously had a breast implant. If the tumor can be excised (lumpectomy) with clear margins without damaging the implant, it may be acceptable to treat these patients with lumpectomy and radiation. Most of the studies show good results with this approach. If you review the studies here most of the patients had high rates of local control and high rates of good to excellent cosmesis, though a few studies showed a high rate of contracture with poor cosmesis.

Generally if radiation is needed, it may be an option to put in expanders prior to radiation but TRAM flaps should wait till after radiation (see review article here).

brstrec2.jpg (4939 bytes) Some women have TRAM reconstruction instead of implants and these patients can also be radiated. In patients diagnosed with breast cancer treated with a mastectomy and who desire reconstruction, this is still possible even if chest wall radiation is required. Most plastic surgeons prefer to have radiation completed prior to the TRAM if possible. There is no standard, but some studies that discuss these issues are presented below.

A recent review stated that "autologous reconstruction with the TRAM or latissimus dorsi flap is the best options for breast reconstruction in patients undergoing radiation therapy." (more information on breast reconstruction go here, and other studies here and here.)