Women with breast cancer who have had a mastectomy have generally had to wait for six to 12 months after surgery and radiation before they get reconstructive surgery.

That long wait between a having a mastectomy and getting reconstructive surgery may become a thing of the past, a recent study suggests.

The approach is likely to be a significant breakthrough for many patients.

By giving breast cancer patients radiation first, before mastectomy, researchers at The University of Texas MD Anderson Cancer Center found that they were able to do reconstruction surgery at the same time as patients had mastectomies, reducing the number of operations a patients had to face and minimizing treatment delays.

Forty-nine patients received radiation therapy followed by mastectomy with immediate breast reconstruction. None of the patients had disease recurrences or flap losses at a median of nearly 30 months of follow-up.

The typical sequence has been to put a tissue expander into place during mastectomy which is then filled with saline. This is followed by approximately six weeks of daily radiation therapy to the remaining chest wall and lymph node tissues. Final reconstruction is typically undertaken six to 12 months after radiation to prevent radiation from reaching the final reconstruction.

For many patients this means their quality of life suffers during this waiting period between radiation and final reconstruction, the result of not having a reconstructed breast. The tissue expander can also create medical issues: One in five women experience complications resulting in removal of the expander.

Changing the order of treatment, beginning with radiation followed by mastectomy and breast reconstruction in one operation, provides immediate benefits to the patient. “This sequence not only enhances surgical outcomes but also eliminates the need for patients to defer breast reconstruction surgery, significantly enhancing their quality of life,” lead author Mark Schaverien, associate professor of Plastic Surgery at Anderson, said in a statement.

“It allows women to swiftly resume their lives following breast cancer treatment, feeling and looking confident, without the need for prolonged delays before undergoing reconstructive surgery.”

The rate of surgical complications after the operation was similar to that of standard reconstructive surgery, a favorable comparison. Patients who underwent short course radiation therapy exhibited similar complication rates to those receiving standard course radiation therapy.

All the patients who underwent tissue-based reconstruction had successful reconstructive surgeries and none of them had any serious complications in follow-up.

The median age of the women in the study was 48, and most — 94 percent — received radiation therapy ahead of surgery. Twenty-four were randomized to receive short course (40.05 Gy/15 fractions) and 25 to receive a standard course (50 Gy/25 fractions) of radiation therapy to the chest wall and regional lymph nodes. At a median of 23 days after completing radiotherapy, the patients underwent mastectomy with immediate breast reconstruction surgery.

The approach is likely to be a significant breakthrough for many patients, the study's co-author Benjamin Smith, a professor of Radiation Oncology and Health Services Research, explained. “It allows women to swiftly resume their lives following breast cancer treatment, feeling and looking confident, without the need for prolonged delays before undergoing reconstructive surgery.”

The team is currently enrolling patients in a Phase III trial to compare the standard amount and timing of radiation treatment with a reduced radiation dose given before breast cancer removal and reconstruction surgery.

The study is published in JAMA Network Open.