BY JEFFREY M. HARTOG, DMD, MD
In my experience over the years, radiation therapy as part of the overall treatment of breast cancer has notably decreased the risk of recurrence and improved overall survival for advanced breast cancer in women undergoing mastectomies. There is also some evidence that it may be beneficial in less advanced cases, as well. In addition, more and more frequently, patients are choosing breast-sparing surgery for breast cancer treatment, and radiation therapy is an essential component of this approach.
Although radiation therapy may be beneficial in terms of the treatment of the cancer itself, we in the medical profession should consider the problems it can create for women seeking breast reconstruction – for example, increased complications, complete failure of breast reconstruction with either implants or tissue flaps, and poor aesthetic outcomes. The radiation may also increase the deformity of the breast in women undergoing lumpectomies due to scarring and contraction of the tissues.
In most cases, women who have undergone lumpectomies followed by radiation are not offered reconstruction at all, despite the fact that they are frequently left with moderate or severe breast deformities and significant breast asymmetry as it relates to the other, untreated breast. Despite the effectiveness in treating breast cancer, radiation therapy results in increasing fibrosis of the tissues and adversely affects the body’s ability to heal itself in the radiated areas.
Fortunately, we now have an effective way to reverse the deleterious effects of radiation therapy, improve outcomes and decrease complications in women undergoing breast reconstruction. Furthermore, women with lumpectomies now have a viable option to reconstruct their breasts and improve symmetry with the opposite side. I have found fat transfer, or fat grafting, to be an effective method to restore the vitality of radiated tissue, facilitate breast reconstruction, and reconstruct breasts treated with lumpectomies followed by radiation.
The fat transfer technique is simple, involves no incisions, and is a 100-percent outpatient procedure. The fat is harvested with a standard gentle liposuction procedure, and then simply injected into the radiated areas using meticulous micrografting techniques. Usually, more than one procedure is required to restore the tissue quality and the breast defect, but now we can simplify the procedure by banking fat harvested with a single liposuction procedure, making subsequent micrografting injection procedures much easier.
Fat grafting works in two ways to restore radiation-damaged tissue. The first and most obvious way is that the fat replaces the scarred and fibrotic tissue and restores the tissue quality and volume. The second, more subtle manner is due to the stem and regenerative cells contained in the fat, which improve the ability of the tissue to heal itself. There is strong evidence that one of the effects of radiation is to destroy and deplete the stem and regenerative cells that normally exist in tissues, and this is one of the factors promoting increased scarring and contraction of radiated tissues. It’s also a possible mechanism of the increased complication rate when breast reconstruction is attempted, particularly with implants.
Depending on the situation, we can use fat transfer alone, as in most lumpectomy patients, or we can use it in combination with implants, as in mastectomy patients. The procedure can also salvage failed or compromised breast reconstructions with flap procedures.
Fat transfer is an essential component in reconstruction of breasts treated with radiation and can make the difference between success or failure. In certain situations, even mastectomy patients who have been heavily radiated may not be considered as candidates for breast reconstruction at all. Frequently, fat transfer can provide a method for reconstruction even for these patients, who have been told that reconstruction is not an option by most plastic surgeons.
Of course, fat transfer is also an option for women who choose not to have reconstruction with artificial implants or tissue flaps requiring major invasive procedures to harvest the flaps from other parts of their bodies.
Because breast reconstruction with fat transfer can be tedious and requires meticulous specialized techniques as well as some patience on the part of the patient, who may need two or more fat transfer procedures, many plastic surgeons do not even offer this procedure to their patients. However, to me, it is unacceptable to expect women to walk away after such life-changing procedures without being offered the option of breast reconstruction.
Women should know they don’t have to live with deformed breasts after radiation. Oncologists should present breast reconstruction options to their patients, including the natural fat transfer procedure.
JEFFREY M. HARTOG, DMD, MD, Director of the Bougainvillea Clinique in Winter Park, Florida, specializes in fat transfer to the breast and presents nationally and internationally on the subject.