Radiation therapy after breast implant reconstruction associated with lower levels of well-being

According to research, women who have breast implant reconstruction, followed by radiation therapy, are not as happy with the results and report lower levels of well-being than women who have the same reconstruction without radiation therapy.

Background & goals

Radiation therapy, the use of high-energy radiation to kill breast cancer cells and shrink tumors, is often used after breast cancer surgery to lessen the risk of the cancer returning.

About 26 to 38 percent of women in the United States who have a total mastectomy, removal of the whole breast, have breast reconstruction surgery to reshape or rebuild the breast(s) immediately afterward. Implants are used in 68 percent of those surgeries – they've been the most commonly used method since 2003.

Past studies show that radiation therapy after breast implant reconstruction is associated with complications, such as tightness, pain, problems with appearance and difficulty moving, but few looked at the effect that these surgeries have on women’s well-being and quality of life.

Design

Researchers used the BREAST-Q, a questionnaire designed to measure breast surgery-related quality of life and happiness. The questionnaire was sent to women who had implant-based breast reconstruction, with and without radiation, at one of three centers in the United States and Canada. Responses were received from 219 women who had radiation therapy and 414 women who didn't, for a total of 633 completed questionnaires.

Results

Women who had implant-based reconstruction followed by radiation therapy reported having a lower quality of life than women who did not have radiation therapy.

Of the total group,

• 58.3 percent of women who had radiation therapy were satisfied with their reconstructed breasts, compared to 64 percent of those who did not
• 66.8 percent of women who had radiation therapy were satisfied with the surgery outcome, compared to 71.4 percent of those who did not
• 66.7 percent of women who had radiation therapy reported psychosocial well-being, compared to 70.9 of those who did not
• 47 percent of women who had radiation therapy reported sexual well-being, compared to 52.3 percent of those who did not
• 71.8 percent of women who had radiation therapy reported physical well-being, compared to 75.1 percent of those who did not

Factors such as carrying less body fat, reconstruction of both breasts rather than one, and having silicone implants rather than saline were associated with higher levels of satisfaction with breasts.

Limitations

Limitations include the fact that women waited different amounts of time to start radiation therapy depending on which clinic they were at. Researchers suggest future studies focus on how the timing, dose, and way in which the radiation therapy is given affect how happy women are with their breasts after implant reconstruction with radiation therapy.

What this means for you

If you’re planning your breast cancer surgery and are undecided about reconstruction options, the information in this study is important to consider. Radiation therapy has been proven beneficial for women who have a high risk of the cancer returning. But  American Society of Clinical Oncology (ASCO) guidelines say there isn’t enough evidence to suggest post-mastectomy radiation therapy be used regularly for women whose cancer is less likely to return.

But radiation therapy is increasingly offered. Side effects can range from mild to serious. When considering radiation therapy after implant reconstruction surgery, talk to your doctor about balancing cancer care with quality of life.

If you've gone through breast implant reconstruction and radiation therapy and are unhappy with the results, talk with your reconstructive surgeon about possible solutions or see another surgeon. A nurse navigator may be able to help you find one who will best fit your needs.

Albornoz, Claudia; Matros, Evan; McCarthy, Colleen et al.  Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction. Annals of Surgical Oncology. July 2014; 10.1245/s10434-014-3483-2.