Radiation is meant to kill any remaining cancer cells in the body in order to prevent a recurrence of breast cancer. While it destroys cancer cells, radiation also affects blood supply to skin and deep tissues and even causes scar tissue. A breast implant would be subject to these changes since it would be directly within the radiation treatment area. Implants placed under the pectoral (chest) muscle would be subject to scarring that occurs in the muscle.
As the skin and muscle scars after radiation therapy, so does the scar capsule surrounding the implant. This puts patients at a greater risk for capsular contracture which occurs when a patient’s body reacts to a foreign object, forming a capsule around the implant. The extra scarring causes the capsule to tighten around the implant, creating a painful condition in which the breast looks hard and abnormal. While the implant itself remains normal, the tissue around it is affected.
Patients can have radiation therapy after TRAM flap reconstruction procedures with tissue expanders. However, it’s important to remember that the tissue will still be affected (i.e., scarring, changes in blood flow). This means the skin used in reconstruction will not be as soft as it would be if it were not part of radiation therapy. Most surgeons will delay breast reconstruction if their patients need radiation so that they may use healthy tissue that hasn’t been affected by the treatment. Although each patient’s situation is unique, in general I prefer the TRAM flap procedure in any situation where radiation therapy is involved.