Radiation Therapy and Breast Reconstruction: A Critical Review of the Literature

Abstract

In patients who will receive or have already received postmastectomy radiation therapy, the optimal approach is delayed autologous tissue reconstruction after postmastectomy radiation therapy. If postmastectomy radiation therapy appears likely but may not be required, delayed-immediate reconstruction may be considered.

Mastectomy with immediate breast reconstruction after neoadjuvant chemotherapy and radiation therapy. A new option for patients with operable invasive breast cancer. Results of a 20 years single institution study

“…There were more delayed complications and more surgical revisions in the group RI (27,3%, RR RI vs. others = 6,4 [2,[6][7][8][9][10][11][12][13][14][15]6]; p=0,0005). Considering all complications, TRAM and RI reconstructions required more surgical revisions than LD reconstructions (RR TRAM vs. LD = 2,7 [1,[4][5]3] and RR RI vs. LD = 4,2 [2,[0][1][2][3][4][5][6][7][8]6]; p=0,0006). Twelve reconstruction failures were noted with 1 complete TRAM flap loss and 11 implants removal (6 in LDI and 5 in RI).…”

“…The mean follow-up was 8 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Five patients were lost to follow-up.…”

“…Several studies have suggested that postoperative RT increases reconstruction complications and affects cosmetic outcomes. 10 The common practice consists of recommending delayed reconstruction or autologous myocutaneous flaps reconstruction 6 . However, results in regards of RT and IBR remain controversial.…”

“…Secondly, RT is more difficult on a reconstructed breast. 6,7 Thirdly, RT may alter the local microcirculation and collagen synthesis, potentially responsible for a progressive fibrosis. 17,18 Thus, it may be more appropriate to perform a reconstruction as soon as possible after the completion of RT in order to avoid the inflammatory reactions.…”

“…Moreover, RT seems to be more difficult after reconstruction leading to some controversies. 6,7 For patients with OIBC, eligible for mastectomy, CT and RT, we designed a different approach in order to match the patient's desire for IBR and the oncologic goals of the treatment. Hence, we decided to perform IBRs at the end of the therapeutic sequence after completion of CT and RT.…”