Advertisement

Breast Cancer Research and Treatment

, Volume 127, Issue 1, pp 15–22 | Cite as

Radiotherapy and breast reconstruction: a meta-analysis

  • M Barry
  • M. R. Kell
Review

Abstract

The optimum sequencing of breast reconstruction (BR) in patients receiving postmastectomy radiation therapy (PMRT) is controversial. A comprehensive search of published studies that examined postoperative morbidity following immediate or delayed BR with combined radiotherapy was performed. Medical (MEDLINE & EMBASE) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured. A total of 1,105 patients were identified from 11 appropriately selected studies. Patients undergoing PMRT and BR are more likely to suffer morbidity compared with patients not receiving PMRT (OR = 4.2; 95% CI, 2.4–7.2 [no PMRT vs. PMRT]). Reconstruction technique was also examined with outcome when PMRT was delivered after BR, and this demonstrated that autologous reconstruction is associated with less morbidity in this setting (OR = 0.21; 95% CI, 0.1–0.4 [autologous vs. implant-based]). Delaying BR until after PMRT had no significant effect on outcome (OR = 0.87; 95% CI, 0.47–1.62 [delayed vs. immediate]). PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared with implant-based reconstruction.

Keywords

Post-mastectomy radiotherapy Immediate and delayed breast reconstruction Prosthetic breast reconstruction Autologous breast reconstruction Postoperative morbidity 

References

  1. 1.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Eng J Med 347:1233–1241CrossRefGoogle Scholar
  2. 2.
    Chevray PM (2008) Timing of breast reconstruction: immediate versus delayed. Cancer J 14(4):223–229PubMedCrossRefGoogle Scholar
  3. 3.
    Meretoja TJ, von Smitten KA, Leidenius MH, Svarvar C, Heikkila PS, Jahkola TA (2007) Local recurrence of stage 1 and 2 breast cancer after skin sparing mastectomy and immediate breast reconstruction in a 15 year series. Eur J Surg Oncol 33:1142–1145PubMedGoogle Scholar
  4. 4.
    Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337:949–955PubMedCrossRefGoogle Scholar
  5. 5.
    Ragaz K, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node positive premenopausal women with breast cancer. N Engl J Med 337:956–962PubMedCrossRefGoogle Scholar
  6. 6.
    Recht A, Edge SB, Solin LJ et al (2001) Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1539–1569PubMedGoogle Scholar
  7. 7.
    Harris JR, Halpin-Murphy P, McNeese M et al (1999) Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 44:989–990PubMedCrossRefGoogle Scholar
  8. 8.
    Rutqvist LE, Rose C, Cavallin-Ståhl E (2003) A systematic overview of radiation therapy effects in breast cancer. Acta Oncol 42(5–6):532–545PubMedCrossRefGoogle Scholar
  9. 9.
    Truong PT, Woodward WA, Bucholz TA (2006) Optimizing locoregional control and survival for women with breast cancer: a review of current developments in postmastectomy radiation. Expert Rev Anticancer Ther 6:205–216PubMedCrossRefGoogle Scholar
  10. 10.
    Wong JS, Ho AY, Kaelin CM, Bishop KL, Silver B, Gelman R, Harris JR, Hergrueter CA (2008) Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy. Breast J 14(1):49–54PubMedCrossRefGoogle Scholar
  11. 11.
    Anderson PR, Hanlon AL, Fowble BL, McNeeley SW, Freedman GM (2004) Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy. Int J Radiat Oncol Biol Phys 59(4):1080–1087PubMedCrossRefGoogle Scholar
  12. 12.
    Thomson HJ, Potter S, Greenwood RJ, Bahl A, Barker J, Cawthorn SJ, Winters ZE (2008) A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 15(4):1081–1091 Epub 26 Jan 2008PubMedCrossRefGoogle Scholar
  13. 13.
    Miller MJ, Rock CS, Robb GL (1996) Aesthetic breast reconstruction using a combination of free transverse rectus abdominis musculocutaneous flaps and breast implants. Ann Plast Surg 37(3):258–264PubMedCrossRefGoogle Scholar
  14. 14.
    Kroll SS, Marchi M (1991) Immediate reconstruction: current status in cancer management. Tex Med 87:67–72PubMedGoogle Scholar
  15. 15.
    Spear SL, Ducic I, Low M, Cuoco F (2005) The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg 115(1):84–95PubMedGoogle Scholar
  16. 16.
    Dean C, Chetty U, Forrest AP (1983) Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1:459–462PubMedCrossRefGoogle Scholar
  17. 17.
    Bloomer WD, Hellman S (1975) Normal issue responses to radiation therapy. N Engl J Med 293:80–83PubMedCrossRefGoogle Scholar
  18. 18.
    Fajardo LF, Berthrong M (1978) Radiation injury in surgical pathology: part I. Am J Surg Pathol 2:159–199PubMedCrossRefGoogle Scholar
  19. 19.
    Fajardo LF (1989) Morphologic patterns of radiation injury. Front Radiat Ther Oncol 23:75–84PubMedGoogle Scholar
  20. 20.
    Kronowitz SJ, Robb GL (2004) Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 114(4):950–960PubMedCrossRefGoogle Scholar
  21. 21.
    Buchholz TA, Kronowitz SJ, Kuerer HM (2002) Immediate breast reconstruction after skin-sparing mastectomy for treatment of advanced breast cancer: radiation oncology considerations. Ann Surg Oncol 9:820–821PubMedCrossRefGoogle Scholar
  22. 22.
    Strålman K, Mollerup CL, Kristoffersen US, Elberg JJ (2008) Long-term outcome after mastectomy with immediate breast reconstruction. Acta Oncol 47(4):704–708PubMedCrossRefGoogle Scholar
  23. 23.
    Huang CJ, Hou MF, Lin SD et al (2006) Comparison of local recurrence and distant metastases between breast cancer patients after postmastectomy radiotherapy with and without immediate TRAM flap reconstruction. Plast Reconstr Surg 118(5):1079–1086PubMedCrossRefGoogle Scholar
  24. 24.
    Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826PubMedGoogle Scholar
  25. 25.
    Tallet AV, Salem N, Moutardier V et al (2003) Radiotherapy and immediate two stage breast reconstruction with a tissue expander and implant: complications and aesthetic results. Int J Radiat Oncol Biol Phys 57(1):136–142PubMedCrossRefGoogle Scholar
  26. 26.
    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(3):713–721PubMedCrossRefGoogle Scholar
  27. 27.
    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(3):877–881PubMedCrossRefGoogle Scholar
  28. 28.
    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 90:141–147PubMedCrossRefGoogle Scholar
  29. 29.
    Jhaveri JD, Rush SC, Kostroff K, Derisi D, Farber LA, Maurer VE, Bosworth JL (2008) Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction. Int J Radiat Oncol Biol Phys 72(3):859–865PubMedCrossRefGoogle Scholar
  30. 30.
    Williams JK, Carlson GW, Bostwick J 3rd, Bried JT, Trimble J, Mackay G (1997) The effects of radiation treatment after TRAM flap breast reconstruction. Plast Reconstr Surg 100(5):1153–1160PubMedCrossRefGoogle Scholar
  31. 31.
    Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL (2001) Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 108(1):78–82PubMedCrossRefGoogle Scholar
  32. 32.
    Ascherman JA, Hanasono MM, Newman MI, Hughes DB (2006) Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg 117(2):359–365PubMedCrossRefGoogle Scholar
  33. 33.
    Motwani SB, Strom EA, Schechter NR, Butler CE, Lee GK, Langstein HN, Kronowitz SJ, Meric-Bernstam F, Ibrahim NK, Buchholz TA (2006) The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys 66(1):76–82PubMedCrossRefGoogle Scholar
  34. 34.
    Kronowitz SJ, Hunt KK, Kuerer HM, Babiera G, McNeese MD, Buchholz TA, Strom EA, Robb GL (2004) Delayed-immediate breast reconstruction. Plast Reconstr Surg 113(6):1617–1628PubMedCrossRefGoogle Scholar
  35. 35.
    McKeown DJ, Hogg FJ, Brown IM, Walker MJ, Scott JR, Weiler-Mithoff EM (2009) The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome. J Plast Reconstr Aesthet Surg 62(4):488–493 Epub 11 Feb 2008PubMedCrossRefGoogle Scholar
  36. 36.
    Kroll SS, Robb GL, Reece GP, Miller MJ, Evans GR, Baldwin BJ, Wang B, Schusterman MA (1998) Does prior irradiation increase the risk of total or partial free-flap loss? J Reconstr Microsurg 14(4):263–268PubMedCrossRefGoogle Scholar
  37. 37.
    Chang DW, Wang B, Robb GL et al (2000) Effect of obesity on flap and donor site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 105:1640–1648PubMedCrossRefGoogle Scholar
  38. 38.
    Chang DW, Reece GP, Wang B (2000) Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg 105:2374–2380PubMedCrossRefGoogle Scholar
  39. 39.
    Saulis AS, Mustoe TA, Fine NA (2007) A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 119:1669–1678PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  1. 1.Department of Breast SurgeryBreastCheck, Mater Misericordiae University HospitalDublinIreland

Personalised recommendations