Radiation Before Mastectomy: Switching Treatment Order Allows for Immediate Reconstruction

If early-stage breast cancer has a high risk of recurrence – coming back after treatment – nearly all doctors recommend radiation after mastectomy. But when a woman wants to have reconstruction, the timing of radiation after surgery is tricky because radiation can cause changes in the reconstructed breast’s appearance and up the risk of complications, such as delayed healing. So many women have a tissue expander placed during mastectomy surgery and then receive radiation. Once the area has recovered from radiation, reconstruction surgery is done, usually about six or 12 months after radiation is completed. In the April 5, 2024, issue of JAMA Network Open, Dr. Benjamin Smith and colleagues published the results of the SAPHIRe trial, which studied whether giving radiation before mastectomy was safe. Listen to the episode to hear Dr. Smith explain: how the idea for the trial came about the benefits and risks of giving radiation before mastectomy why women having implant reconstruction aren’t good candidates for radiation before mastectomy next steps, including the phase III TOPAz trial

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