Abstract
Use of postmastectomy radiotherapy (PMRT) has increased over time. The timing and sequencing of radiotherapy in the context of breast reconstruction remain controversial. Immediate breast reconstruction has several psychological, economic, and social advantages, but, by altering the chest wall anatomy, may complicate delivery of PMRT and increase the risk of complications and impaired cosmesis. Delayed breast reconstruction can be challenging, and has the difficulty of operating in previously irradiated fields. A modern radiotherapy approach is needed to minimize the risk of complications. In a PMRT setting, the overall complication rate increases compared with that for nonirradiated patients, irrespective of whether breast reconstruction is performed before or after radiotherapy. Autologous tissue appears to handle PMRT better than allogeneic tissue and is the favorite choice for patients who are candidate to receive PMRT or who have had previous radiotherapy. Many factors are identified as significant predictors of outcome. Despite the rates of complications and reconstruction failure, aesthetic and general satisfaction are generally high.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
MacDonald SM, Harris EE, Arthur DW et al (2011) ACR Appropriateness Criteria® locally advanced breast cancer. Breast J 17:579–585
Kaufmann M, Morrow M, von Minckwitz G et al (2010) Locoregional treatment of primary breast cancer: consensus recommendations from an international expert panel. Cancer 116:1184–1191
Robinson DW (1975) Surgical problems in the excision and repair of radiated tissue. Plast Reconstr Surg 55:41–49
Rudolph R (1982) Complications of surgery for radiotherapy skin damage. Plast Reconstr Surg 70:179–185
Soong IS, Yau TK, Ho CM, Lim et al (2004) Post-mastectomy radiotherapy after immediate autologous breast reconstruction in primary treatment of breast cancers. Clin Oncol (R Coll Radiol) 16:283–289
Hazard L, Miercort C, Gaffney D et al (2004) Local-regional radiation therapy after breast reconstruction: what is the appropriate target volume? A case-control study of patients treated with electron arc radiotherapy and review of the literature. Am J Clin Oncol 27:555–564
Al-Ghazal SK, Sully L, Fallowfield L et al (2000) The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26:17–19
Khoo A, Kroll SS, Reece GP et al (1998) A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg 101:964–968
Buchholz TA, Kronowitz SJ, Kuerer HM (2002) Immediate breast reconstruction after skin-sparing mastectomy for the treatment of advanced breast cancer: radiation oncology considerations. Ann Surg Oncol 9:820–821
Motwani SB, Strom EA, Schechter NR et al (2006) The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys 66:76–82
Alderman AK, Wilkins EG, Kim HM et al (2002) Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109:2265–2274
Temple CL, Strom EA, Youssef A et al (2005) Choice of recipient vessels in delayed TRAM flap breast reconstruction after radiotherapy. Plast Reconstr Surg 115:105–113
Barry M, Kell MR (2011) Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat 127:15–22
Spear SL, Onyewu C (2000) Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg 105:930–942
Ascherman JA, Hanasono MM, Newman MI et al (2006) Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg 117:359–365
Adesiyun TA, Lee BT, Yueh JH et al (2011) Impact of sequencing of postmastectomy radiotherapy and breast reconstruction on timing and rate of complications and patient satisfaction. Int J Radiat Oncol Biol Phys 80:392–397
Lee BT, A Adesiyun T, Colakoglu S, et al (2010) Postmastectomy radiation therapy and breast reconstruction: an analysis of complications and patient satisfaction. Ann Plast Surg 64:679–683
Tran NV, Chang DW, Gupta A et al (2001) Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 108:78–82
Javaid M, Song F, Leinster S et al (2006) Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: an argument about timing. J Plast Reconstr Aesthet Surg 59:16–26
Chawla AK, Kachnic LA, Taghian AG et al (2002) Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant. Int J Radiat Oncol Biol Phys 54:520–526
Rogers NE, Allen RJ (2002) Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 109:1919–1924
Williams JK, Carlson GW, Bostwick J 3rd et al (1997) The effects of radiation treatment after TRAM flap breast reconstruction. Plast Reconstr Surg 100:1153–1160
Baumann DP, Crosby MA, Selber JC et al (2011) Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy. Plast Reconstr Surg 127:1100–1106
Contant CM, van Geel AN, van der Holt B et al (2000) Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol 26:344–350
Pinsolle V, Grinfeder C, Mathoulin-Pelissier S et al (2006) Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg 59:1017–1024
Behranwala KA, Dua RS, Ross GM et al (2006) The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants. J Plast Reconstr Aesthet Surg 59:1043–1051
Tallet AV, Salem N, Moutardier V et al (2003) Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results. Int J Radiat Oncol Biol Phys 57:136–142
Goodman CM, Miller R, Patrick CW Jr et al (2002) Radiotherapy: effects on expanded skin. Plast Reconstr Surg 110:1080–1083
Barnsley GP, Sigurdson LJ, Barnsley SE (2006) Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. Plast Reconstr Surg 117:2182–2190
Spear SL, Boehmler JH, Bogue DP et al (2008) Options in reconstructing the irradiated breast. Plast Reconstr Surg 122:379–388
Kronowitz SJ (2010) Delayed-immediate breast reconstruction: technical and timing considerations. Plast Reconstr Surg 125:463–474
Nahabedian MY (2009) Breast reconstruction: a review and rationale for patient selection. Plast Reconstr Surg 124:55–62
Jhaveri JD, Rush SC, Kostroff K et al (2008) Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction. Int J Radiat Oncol Biol Phys 72:859–865
Berry T, Brooks S, Sydow N et al (2010) Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Oncol 17(Suppl 3):202–210
Anderson PR, Freedman G, Nicolaou N et al (2009) Postmastectomy chest wall radiation to a temporary tissue expander or permanent breast implant–is there a difference in complication rates? Int J Radiat Oncol Biol Phys 74:81–85
Embrey M, Adams EE, Cunningham B et al (1999) A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions. Aesthetic Plast Surg 23:197–206
Lipa JE, Qiu W, Huang N et al (2010) Pathogenesis of radiation-induced capsular contracture in tissue expander and implant breast reconstruction. Plast Reconstr Surg 125:437–445
McCarthy CM, Pusic AL, Disa JJ et al (2005) Unilateral postoperative chest wall radiotherapy in bilateral tissue expander/implant reconstruction patients: a prospective outcomes analysis. Plast Reconstr Surg 116:1642–1647
Cordeiro PG, Pusic AL, Disa JJ et al (2004) Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 113:877–881
Vandeweyer E, Deraemaecker R (2000) Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg 106:56–58
Krueger EA, Wilkins EG, Strawderman M et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49:713–721
Drucker-Zertuche M, Bargallo-Rocha E, Zamora-Del RR (2011) Radiotherapy and immediate expander/implant breast reconstruction: should reconstruction be delayed? Breast J. 17:365–370
Tseng J, Huang AH, Wong MS, et al (2010) Rib fractures: a complication of radiation therapy and tissue expansion for breast reconstruction.Plast Reconstr Surg 125:65e–66e
Parsa AA, Jackowe DJ, Johnson EW et al (2009) Selection criteria for expander/implant breast reconstruction following radiation therapy. Hawaii Med J 68:66–68
Hunt KK, Baldwin BJ, Strom EA et al (1997) Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction. Ann Surg Oncol 4:377–384
Zimmerman RP, Mark RJ, Kim AI et al (1998) Radiation tolerance of transverse rectus abdominis myocutaneous-free flaps used in immediate breast reconstruction. Am J Clin Oncol 21:381–385
Spear SL, Newman MK, Bedford MS et al (2008) A retrospective analysis of outcomes using three common methods for immediate breast reconstruction. Plast Reconstr Surg 122:340–347
Tran NV, Evans GR, Kroll SS et al (2000) Postoperative adjuvant irradiation: effects on tranverse rectus abdominis muscle flap breast reconstruction. Plast Reconstr Surg 106:313–317
Carlson GW, Page AL, Peters K et al (2008) Effects of radiation therapy on pedicled transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg 60:568–572
Kroll SS, Robb GL, Reece GP et al (1998) Does prior irradiation increase the risk of total or partial free-flap loss? J Reconstr Microsurg 14:263–268
Spear SL, Ducic I, Low M et al (2005) The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg 115:84–95
Disa JJ, Cordeiro PG, Heerdt AH et al (2003) Skin-sparing mastectomy and immediate autologous tissue reconstruction after whole-breast irradiation. Plast Reconstr Surg 111:118–124
Jacobsen WM, Meland NB, Woods JE (1994) Autologous breast reconstruction with use of transverse rectus abdominis musculocutaneous flap: Mayo clinic experience with 147 cases. Mayo Clin Proc 69:635–640
Albino FP, Koltz PF, Ling MN et al (2010) Irradiated autologous breast reconstructions: effects of patient factors and treatment variables. Plast Reconstr Surg 126:12–16
Spear SL, Boehmler JH, Taylor NS et al (2007) The role of the latissimus dorsi flap in reconstruction of the irradiated breast. Plast Reconstr Surg 119:1–9
Chang DW, Barnea Y, Robb G (2008) Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts. Plast Reconstr Surg 122:356–362
Moore TS, Farrell LD (1992) Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg 89:666–672
McKeown DJ, Hogg FJ, Brown IM et al (2009) The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome. J Plast Reconstr Aesthet Surg 62:488–493
Apffelstaedt J (2002) Indications and complications of latissimus dorsi myocutaneous flaps in oncologic breast surgery. World J Surg 26:1088–1093
Rogers NE, Allen RJ (2002) Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 109:1919–1924
Chatterjee JS, Lee A, Anderson W, Baker L (2009) Effect of postoperative radiotherapy on autologous deep inferior epigastric perforator flap volume after immediate breast reconstruction. Br J Surg 96:1135–1140
Whitfield GA, Horan G, Irwin MS et al (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions. Radiother Oncol 90:141–147
Mehta VK, Goffinet D (2004) Postmastectomy radiation therapy after TRAM flap breast reconstruction. Breast J 10:118–122
McDonald MW, Godette KD, Butker EK et al (2008) Long-term outcomes of IMRT for breast cancer: a single-institution cohort analysis. Int J Radiat Oncol Biol Phys 72:1031–1040
Kuske RR, Schuster R, Klein E et al (1991) Radiotherapy and breast reconstruction: clinical results and dosimetry. Int J Radiat Oncol Biol Phys 21:339–346
Buchholz TA, Strom EA, Perkins GH et al (2002) Controversies regarding the use of radiation after mastectomy in breast cancer. Oncologist 7:539–546
Schechter NR, Strom EA, Perkins GH et al (2005) Immediate breast reconstruction can impact postmastectomy irradiation. Am J Clin Oncol 28:485–494
Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 337:949–955
Koutcher L, Ballangrud A, Cordeiro PG et al (2010) Postmastectomy intensity modulated radiation therapy following immediate expander-implant reconstruction. Radiother Oncol 94:319–323
Krishnan L, Krishnan EC (1986) Electron beam irradiation after reconstruction with silicone gel implant in breast cancer. Am J Clin Oncol 9:223–226
Piroth MD, Piroth DM, Pinkawa M et al (2009) Immediate reconstruction with an expander/implant following ablatio mammae because of breast cancer : side effects and cosmetic results after adjuvant chest wall radiotherapy. Strahlenther Onkol 185:669–674
Shankar RA, Nibhanupudy JR, Sridhar R et al (2003) Immediate breast reconstruction-impact on radiation management. J Natl Med Assoc 95:286–295
Moni J, Graves-Ditman M, Cederna P et al (2004) Dosimetry around metallic ports in tissue expanders in patients receiving postmastectomy radiation therapy: an ex vivo evaluation. Med Dosim 29:49–54
Thompson RC, Morgan AM (2005) Investigation into dosimetric effect of a MAGNA-SITE tissue expander on post-mastectomy radiotherapy. Med Phys 32:1640–1646
Damast S, Beal K, Ballangrud A et al (2006) Do metallic ports in tissue expanders affect postmastectomy radiation delivery? Int J Radiat Oncol Biol Phys 66:305–310
Hanks SH, Lyons JA, Crowe J et al (2000) The acute effects of postoperative radiation therapy on the transverse rectus abdominis myocutaneous flap used in immediate breast reconstruction. Int J Radiat Oncol Biol Phys 47:1185–1190
Halpern J, McNeese MD, Kroll SS et al (1990) Irradiation of prosthetically augmented breasts: a retrospective study on toxicity and cosmetic results. Int J Radiat Oncol Biol Phys 18:189–191
Collis N, Coleman D, Foo IT et al (2000) Ten-year review of a prospective randomized controlled trial of textured versus smooth subglandular silicone gel breast implants. Plast Reconstr Surg 106:786–791
Fosnot J, Fischer JP, Smartt JM Jr et al (2011) Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction? Plast Reconstr Surg 127:496–504
Michy T, Gimbergues P, Le Bouëdec G et al (2007) What surgical procedure for immediate breast reconstruction after preoperative radiotherapy and chemotherapy? J Chir 144:511–515
Freeman ME, Perdikis G, Sternberg EG et al (2006) Latissimus dorsi reconstruction: a good option for patients with failed breast conservation therapy. Ann Plast Surg 57:134–137
de Wildt RP, Tuinder S, van der Hulst RR (2009) Substantial chest-wall deformity following tissue expansion after radiotherapy. Eur J Plast Surg 32:337–340
Persichetti P, Cagli B, Simone P et al (2009) Implant breast reconstruction after salvage mastectomy in previously irradiated patients. Ann Plast Surg 62:350–354
Thomson HJ, Potter S, Greenwood RJ et al (2008) A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 15:1081–1091
Victor SJ, Brown DM, Horwitz EM et al (1998) Treatment outcome with radiation therapy after breast augmentation or reconstruction in patients with primary breast carcinoma. Cancer 82:1303–1309
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Italia
About this chapter
Cite this chapter
Orecchia, R., Leonardi, M.C., Dell’Acqua, V. (2013). Principles and Consequences of Radiotherapy for Breast Reconstruction. In: Urban, C., Rietjens, M. (eds) Oncoplastic and Reconstructive Breast Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2652-0_10
Download citation
DOI: https://doi.org/10.1007/978-88-470-2652-0_10
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2651-3
Online ISBN: 978-88-470-2652-0
eBook Packages: MedicineMedicine (R0)