Researchers also did not address the women who chose not to undergo any form of reconstruction after mastectomy. It would be useful to have included such a group for comparison of psychosocial measures. There are always problems inherent in studies based on surveys that rely on patient impressions and judgments. Not every reconstruction procedure is available to every woman. For example, if a woman expects to have radiation therapy after mastectomy, implants are not a good option.
Radiation can cause the skin near the implant to contract, leading to a poor looking result.
Chemotherapy generally has no such effect on an implant, but a woman may still need to wait. The TRAM procedure might tolerate radiation therapy better, since natural tissue is used. However, lately there's been discussion that problems have later arisen with TRAM after radiation as well. After the breast is removed, a tissue expander is placed under the skin and muscle at the time of surgery. At a later date, the expander is exchanged for the implant and the procedure is complete.