Most treatments for breast cancer that conserve the breast involve radiation therapy to control local disease. In effect, the radiation is a substitute for total mastectomy.

The one factor that most affects the choice and timing of reconstructive surgery is radiation therapy. Radiation has immediate effects on both implants and 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, loss of skin. It also can damage to the tiny blood vessels in the soft tissue (reduced vascularization). As a result, there are fewer options for autologous tissue reconstruction and it is more difficult to do.

Furthermore, radiation therapy does not absolutely protect against future cancer in the affected breast. In fact, it may increase the risk in certain patients. Subsequent surgery on the irradiated breast is more risky since there is damage to the tiny blood vessels in the soft tissue.