Most breast cancer treatments that conserve the breast involve radiation therapy to control local disease. In effect, the radiation is a substitute for a total mastectomy. Occasionally, radiation is even recommended after a mastectomy if there is a high risk of local recurrence of the cancer.
Radiation therapy is one factor that most influences the choice and timing of reconstructive surgery. Radiation has immediate effects on implants as well as autologous tissue. It causes increased risk of implant hardening and shrinkage of flap tissue.
Radiation also affects delayed reconstruction. It can result in poor or delayed healing and loss of skin. It also can damage the tiny blood vessels in the soft tissue (reduced vascularization). As a result, there are fewer options for autologous tissue reconstruction, and subsequent surgery on the irradiated tissue is more risky since there is damage to the tiny blood vessels in the soft tissue.