Radiation Wounds & Injury around the Breast for Cancer

By February 20, 2011Reconstructive Surgery
Radiation treatment (RT) is a double edge sword in the treatment of cancers.  Just as with chemotherapy, it attacks the cancers cells, but also damages normal cells.   This is quite evident when the “marks” of radiation are left behind on the skin in the form of a tattoo, and more seriously, as a radiation wound that may ulcerate or turn into cancer.  RT is a common treatment for breast cancer, especially for “breast conservation” techniques and to treat the local area for possible recurrence even after mastectomy.

Despite advanceces in RT, long-term complications of radiation injury are still quite common, in the range of 20%,  Depending upon the cycle and total dose, the body’s response to radiation is similar to a “burn.”  There is soft tissue fibrosis and decreased blood flow which can lead to ulceration, tissue necrosis, infection, chronic wounds, and sometimes, cancer.  This may not be apparent for many years, but it is often a slow, progressive injury with difficult treatment options.   .

RT makes wound healing extrmely difficult because of the tissue”fibrosis” and decreased blood flow. Once a wound forms in a radiated area, it is often a sign of more serious injury deep below the skin, including muscles, bones, cartilage, blood vessels and nerves.   Typical “wound care” with dressings are usually not enough to heal this damaged area.   Hyperbaric oxygen (HBO) may help in these circumstances, but ultimately, the radiated wound needs additional blood flow and cleaning out of the damaged and/or necrotic/infected tissue.  Additional oxygen with HBO can only do so much when blood flow has already been reduced by the RT.     

In select wounds, especially around the breast, the best form of treatment to heal radiation damaged breast tissue is with new, non radiated tissue that is brought to the area with additional blood flow, in the form of a “flap.”   This reqiures careful assesment and planning and is the gold standard by which a complex wound can be healed.    Fortunatley, around the breast, there are many options to bring new tissue from the abdomen or back to treat the damaged area.    The breast can be completely reconstructed at the same time as the wound with designer flaps such as the DIEP or SIEA perforator flap in a single procedure.

Most importantly, the health practitioner must recognize when the current treatment of an irradiated breast wound is not working.   Far too often, I have seen patients who have had over 100 treatments with HBO, or years of a chronic, nonhealing wound, or with recurrent implant/tissue expander infections/capsular contracture.    3 months is the maximum time that a wound should be treated in the same manner with minimal progress;  it is at this time that a higher, expert level of assesment must be performed to determine further treatment options.