breast augmentation after radiation

there is a lot of controversy about who needsto get radiation after a mastectomy, particularly if they have one to three lymph nodes positive.here is what i like to tell my patients. there is an ongoing controversy these daysabout who benefits from radiation in the setting of node positivity. we have historically knownthat women with four or more lymph nodes need to get radiation to the lymph nodes, particularlyif they have had a mastectomy,that would be one of the strong indications for proceedingwith post-mastectomy radiation. in the 1998 or so, two studies came out that suggestedthat there may be a benefit, particularly in younger women to get post-mastectomy radiationfor one to three nodes positive and that began this whole controversy that continues todayand there is ongoing data that continues to

raise the question as to is there a benefitand how big is that benefit for a woman with one to three nodes positive. it is one ofthose topics that i spent hours with patients discussing because there are arguments onboth sides. particularly, if a woman has had a mastectomy and is having reconstruction,the downside to doing radiation is that it may significantly impact upon her reconstruction.otherwise, the radiation is relatively safe and the downsides of it are fairly minimal,so that for women who are having a lumpectomy and have one to three nodes positive, it frequentlyis a much easier decision because we are already doing radiation, so it certainly feels a littlebit bigger, does not change things that much, but it is really in the setting of post-mastectomyradiation that we really come into the controversy

and it is a case by case scenario. it depends,i always looked at it, how many negative features are pushing me to suggest we may need to doit, is it someone who may have what we call lymphovascular invasion where the tumor isshowing evidence of being in some of the lymphatic vessels streaking away from the actual cancersuggesting that there may be a higher recurrence rate in the chest wall or is it someone thatmay have extranodal extension, tumor extending outside the lymph node into the adjacent fat.so there are many factors that go into play and it is again something that needs to bediscussed with the radiation oncologist and each patient has an individualized decisionmaking and will be a participant in that decision making as well because it is not a black andwhite decision.

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