Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology

Abstract

Breast reconstruction (BR) represents a suitable option for women who are not expected to require postmastectomy radiotherapy (PMRT). As recent evidence has led to an extension of the indications for PMRT, this has also appeared to increase the incidence of reconstructive complications. Nevertheless, in the USA at least, trends towards BR are changing. The frequency of immediate reconstruction continues to increase, even in the setting of PMRT. In immediate implant-based reconstruction, a staged approach is preferred. The failure rate of PMRT in implant patients is lower than that with expander patients. In delayed implant-based construction, tissue expansion of irradiated skin leads to a significantly increased risk of complications. In contrast, autologous tissue appears to tolerate radiation damage better than implant-based reconstructions. No significant differences have been described when complication rates of immediate autologous tissue BR with PMRT were compared with delayed autologous tissue BR following PMRT. In previously radiated patients, autologous tissue BR is preferred, and it may be safer when carried out ≥ 12 months after PMRT. Several other problems are associated with radiation delivery after BR and the clues to solve them are reviewed in this paper.

Determination of the appropriate physical density of internal metallic ports in temporary tissue expanders for the treatment planning of post-mastectomy radiation therapy

“…dual-energy CT or algorithms) may be useful when planning CT for PMRT patients with a TTE [ 12 – 15 ]. Accordingly, accurate contouring and the method described in this report for determining the appropriate density for the metallic port may lead to better PMRT planning to compensate for dose reduction by adapting technologies such as IMRT or intensity-modulated proton therapy [ 16 , 17 ].…”

Oral curcumin for radiation dermatitis: a URCC NCORP study of 686 breast cancer patients

“…After breast reconstruction, the skin is more likely to burn due to its inability to dissipate heat [8]. The complication risks from RT differ between autologous tissue reconstructions and implant/expander reconstructions [40, 41]. We could not use breast reconstruction as a factor in the statistical analyses due to lack of documentation of which patients had reconstructions prior to RT.…”

Does Chemotherapy or Radiotherapy Affect for Postoperative Complication in Patients Who Underwent Immediate Breast Reconstruction With Tissue Expander?

“…It has been a controversy whether it is appropriate to do an IR or to do a delayed breast reconstruction in patients with advanced breast cancer. Chemotherapy may be associated toxicity, immunosuppression, and fat necrosis, which may lead to wound healing and PMRT may cause local damage such as fat necrosis, wound dehiscence, ap brosis [36,37]. Therefore, clinicians have not actively recommended IR in patients who were expected to have adjuvant chemotherapy or radiotherapy because it is possible to increase the probability of recurrence by missing the appropriate timing of adjuvant chemotherapy or radiotherapy.…”