TL;DR: Breast cancer radiation can damage healthy tissue years or decades after treatment. The chest wall, ribs, and overlying skin are common sites. Hyperbaric oxygen therapy (HBOT) addresses this damage by stimulating new blood vessel growth in radiation-injured tissue. The 2024 HONEY randomised trial and a 2025 randomised pilot in breast cancer survivors both reported improvements in late local toxic effects with HBOT. In Canada, HBOT for late effects of radiation is one of the 14 Health Canada-recognised indications and is covered at hospital hyperbaric programmes under provincial health insurance.
April is Daffodil Month in Canada. The Canadian Cancer Society has used the daffodil as a symbol of strength and survivorship since 1957. For breast cancer survivors living with the late effects of chest-wall radiation, the question is rarely “did the cancer come back?” Most often it is “what is this new chest pain, and why is it happening years after my treatment ended?”
This guide explains what chest wall radiation injury is, why it happens, how hyperbaric oxygen therapy is used as part of treatment, and how to access HBOT in Canada.
What is chest wall radiation injury?
Chest wall radiation injury is delayed damage to the skin, soft tissue, ribs, and underlying structures of the chest wall caused by radiation therapy delivered for breast cancer or other thoracic malignancy. The damage is not from cancer recurrence; it is from the radiation itself slowly impairing the small blood vessels in the treated area. As blood supply to the tissue worsens over months and years, the affected area becomes progressively hypoxic, fibrotic, and fragile. Common manifestations include radiation dermatitis (skin), soft tissue radiation necrosis, osteoradionecrosis of the ribs (bone), and chronic non-healing wounds in the radiated field.
It affects an estimated 5 to 15 percent of patients who receive therapeutic radiation, and the absolute number is rising as breast cancer survival improves. Symptoms can appear months after radiation, but often emerge years or even decades later. A 2015 case report described radionecrosis presenting 30 years after the original breast cancer treatment.
What does chest wall radiation injury look like?
The presentation depends on which tissue is affected. Most patients experience more than one of the following:
- Skin changes: persistent redness, thickening (fibrosis), telangiectasia (fine red vessel patterns), itching, and discoloration in the radiated field
- Chronic ulcers: non-healing wounds that open, crust, or weep months to years after radiation
- Chest-wall pain: deep, dull, and often worse with movement or pressure, suggesting underlying bone or soft-tissue involvement
- Rib fractures without trauma: spontaneous (pathological) fractures of irradiated ribs, sometimes the first sign of osteoradionecrosis
- Draining sinus tracts: small persistent openings in the skin that drain fluid, signalling deeper bone or tissue necrosis
- Reconstruction failure: failure of breast reconstruction (skin flap, tissue expander, implant) due to inadequate blood supply in the irradiated field
Any new chest-wall pain, skin breakdown, or palpable bony irregularity in a previously irradiated area should be discussed with your oncologist or family physician. Imaging (CT or MRI) and sometimes biopsy are used to distinguish radiation-related changes from cancer recurrence.
How does HBOT help chest wall radiation injury?
Radiation damages tissue mainly by progressively destroying small blood vessels (microvasculature) in the treated area. As vessel density falls, oxygen delivery falls. Without enough oxygen, fibroblasts cannot make collagen, immune cells cannot fight infection, and tissue cannot heal.
HBOT addresses this through a well-documented angiogenesis (new blood vessel growth) mechanism. Repeated exposure to oxygen at 2.0 to 2.4 atmospheres of pressure triggers vascular endothelial growth factor (VEGF) release, which drives capillary budding in irradiated tissue. After 20 to 30 sessions, vascular density in radiation-injured tissue can rise to approximately 75 to 80 percent of non-irradiated tissue levels. This neovascularisation is permanent: the new blood vessels remain after treatment ends, and tissue oxygenation continues to improve over months.
For breast cancer survivors specifically, the HONEY randomized clinical trial (2024) evaluated HBOT for late local toxic effects in irradiated breast cancer patients. A separate 2025 randomized pilot study assessed HBOT for radiation-induced dermatitis in breast cancer. Both trials add to the broader evidence supporting HBOT for late effects of radiation.
What does treatment look like?
Treatment is delivered in a hyperbaric chamber operated by a hospital hyperbaric medicine programme. A typical course for chest wall and rib injury involves the following:
| Treatment element | Typical value |
|---|---|
| Pressure | 2.0 to 2.4 ATA (atmospheres absolute) |
| Session duration | 90 minutes (some radiation protocols extend to 120 minutes) |
| Frequency | Daily, five days per week |
| Soft-tissue / dermatitis course | 30 to 40 sessions |
| Osteoradionecrosis of ribs | 30 to 40 sessions, plus 10 additional if surgical resection of necrotic bone is planned |
| Reconstruction support | Pre- and post-operative, typically 10 to 20 sessions split around surgery |
During each session you lie comfortably in the chamber and breathe pure oxygen. You will feel pressure in your ears during compression (similar to descending in an aircraft) and the technologist will guide you through ear-equalisation manoeuvres. Most patients read, watch streaming video, or sleep through sessions. Treatment is non-invasive and painless.
Can HBOT help with breast reconstruction failure?
Yes, in selected cases. Breast reconstruction after mastectomy (whether skin flap, tissue expander, or implant-based) can fail when the radiated chest wall cannot deliver enough oxygen to support graft survival. HBOT is used both pre-operatively (to prepare the wound bed by improving vascularity) and post-operatively (to rescue compromised flaps or skin grafts before failure progresses).
A 2025 single-institution retrospective analysis evaluated HBOT for mastectomy skin flap ischaemia in breast reconstruction. The use of HBOT for compromised grafts and flaps is one of the 14 Health Canada-recognised indications. Coordination between your reconstructive plastic surgeon and the hyperbaric medicine programme is the standard pathway for this combined surgical-and-HBOT approach.
How do I access HBOT for chest wall radiation injury in Canada?
Late effects of radiation, including chest-wall and rib injury, are one of the 14 Health Canada-recognised conditions for which HBOT is the established standard of care. Treatment is covered at hospital hyperbaric programmes under provincial health insurance: OHIP in Ontario, MSP in British Columbia, AHCIP in Alberta, RAMQ in Quebec, MSI in Nova Scotia, MCP in Newfoundland and Labrador, and Saskatchewan Health.
The first step is a referral from your oncologist, radiation oncologist, family physician, or surgeon to the nearest hospital hyperbaric programme. The referral should include your radiation treatment details (dose, fields, dates), current symptoms, recent imaging, and a clear clinical question. Patients in provinces without an in-province hospital hyperbaric programme (Manitoba, New Brunswick, Prince Edward Island, Yukon, Northwest Territories, Nunavut) are referred interprovincially under their provincial health plan; travel and accommodation are usually the patient’s responsibility unless covered by a specific medical-travel programme.
The Canada Hyperbarics facilities directory lists all 32 verified Canadian HBOT facilities (11 hospital programmes, 22 private clinics) with phone numbers and contact details. Use the postal-code lookup to find the closest facility to you. For a full breakdown of late-effects-of-radiation coverage and the referral pathway, see our delayed radiation injury guide.
Frequently asked questions
How long after radiation can chest wall injury appear?
Chest wall radiation injury can appear anywhere from six months to thirty or more years after radiation therapy ends. Most cases develop within two to five years, but some present decades later. The risk increases over time as radiation-damaged blood vessels progressively fail.
Is chest wall pain after breast radiation always radiation injury?
No. Chest wall pain in a breast cancer survivor can have several causes, including musculoskeletal issues, post-surgical scar pain, or, importantly, cancer recurrence. Any new or worsening chest pain in a previously irradiated area should be assessed by your oncologist with appropriate imaging to rule out recurrence before assuming radiation injury.
Can HBOT treat osteoradionecrosis of the ribs?
Yes. Osteoradionecrosis of the ribs is a recognised late effect of thoracic radiation, and HBOT is one of the standard treatments. Standard course is 30 to 40 daily sessions at 2.0 to 2.4 ATA, with an additional 10 sessions if surgical resection of necrotic bone is planned. A 2015 case series, Osteoradionecrosis of the Ribs following Breast Radiotherapy, documents this presentation in breast cancer survivors specifically.
Will HBOT make cancer come back?
No. There is no clinical evidence that HBOT promotes cancer growth or recurrence. The Undersea and Hyperbaric Medical Society position statement and multiple safety reviews confirm that HBOT is safe for cancer survivors, including those with a history of breast cancer.
How many HBOT sessions will I need?
For chest wall and rib injury, a typical course is 30 to 40 daily sessions, with an additional 10 sessions if surgery is planned. For radiation-related skin and soft-tissue changes, the course is similar. Pre- and post-reconstruction support is shorter, typically 10 to 20 sessions split around surgery. Your hyperbaric medicine team will tailor the course to your specific situation.
Is HBOT covered by my provincial health plan for breast cancer late effects?
Yes, when delivered at a hospital hyperbaric programme with a physician referral. Late effects of radiation is one of the 14 Health Canada-recognised conditions covered by OHIP, MSP, AHCIP, RAMQ, MSI, MCP, and Saskatchewan Health at hospital programmes. Private hyperbaric clinic treatment is generally not provincially covered; some private extended-health insurance plans cover specific indications, so confirm with your plan administrator.
What if I am too far from a hospital hyperbaric programme?
Patients in provinces without an in-province hospital programme are referred interprovincially. The treatment course typically requires daily sessions over six to eight weeks, so most patients arrange temporary accommodation near the receiving facility. Some provinces offer medical-travel-and-accommodation programmes for out-of-province specialty care; check with your provincial Ministry of Health.
Key takeaway
Chest wall and rib radiation injury are recognised late effects of breast cancer radiation, sometimes appearing decades after treatment. Hyperbaric oxygen therapy stimulates permanent new blood vessel growth in radiation-damaged tissue and is one of the established treatments. In Canada, HBOT for late effects of radiation is covered by provincial health insurance at hospital hyperbaric programmes with a physician referral.
If you are a breast cancer survivor experiencing new chest-wall symptoms in a previously radiated area, raise it with your oncologist or family physician. Canada Hyperbarics is an independent educational resource; we do not provide medical care, but we maintain the most comprehensive Canadian HBOT facility directory and coverage information to help you connect with the right programme. This Daffodil Month, the Canadian Cancer Society reminds us that survivorship is more than the absence of cancer; it is reclaiming quality of life. For many breast cancer survivors with late radiation effects, that journey can include HBOT.
References
- HONEY randomised clinical trial. Hyperbaric oxygen therapy and late local toxic effects in patients with irradiated breast cancer. Study summary on Canada Hyperbarics. PMID 38329746.
- Efficacy and safety of hyperbaric oxygen therapy for radiation-induced dermatitis in patients with breast cancer: a randomised pilot study (2025). Study summary on Canada Hyperbarics. PMID 40259026.
- Osteoradionecrosis of the Ribs following Breast Radiotherapy (2015). Study summary on Canada Hyperbarics. PMID 26351442.
- Evaluating the effect of hyperbaric oxygen therapy to treat mastectomy skin flap ischaemia in breast reconstruction (2025). Study summary on Canada Hyperbarics. PMID 39609143.
- Radionecrosis 30 years after breast cancer (2015). Study summary on Canada Hyperbarics. PMID 25972654.
- Health Canada. Hyperbaric oxygen therapy. canada.ca.
- Canadian Cancer Society. Daffodil Month. cancer.ca.
This article is provided by Canada Hyperbarics for informational purposes only and does not constitute medical advice. Decisions about HBOT, breast cancer aftercare, and management of late radiation effects should be made in consultation with your oncologist, radiation oncologist, family physician, or other qualified health-care provider.