Immediate Breast Reconstruction can Impact Postmastectomy Irradiation

Schechter, Naomi R.; Strom, Eric A.; Perkins, George H.; Arzu, Isidora; McNeese, Marsha D.; Langstein, Howard N.; Kronowitz, Steven J.; Meric‐Bernstam, Funda; Babiera, Gildy; Hunt, Kelly K.; Hortobágyi, Gabriel N.; Buchholz, Thomas A.

doi:10.1097/01.coc.0000170582.38634.b6

Cited by 82 publications

(48 citation statements)

References 49 publications

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“…Third, some studies have raised the concern that irradiation of the immediately reconstructed breast results in a lower quality of radiation. These studies showed that the majority of radiation plans are unsatisfactory in terms of providing broad coverage of the chest wall and internal mammary nodes while adequately sparing heart and lung [35][36][37]. Fourth, recent studies reported increased tumor recurrence and patient demise when RT was performed following breast reconstruction in comparison with RT delivered before reconstruction [37][38][39].…”

Section: Introductionmentioning

confidence: 99%

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

Giacalone

Rathat

Daurès

et al. 2010

Breast Cancer Res Treat

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Feasibility and oncological safety of postadjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA-IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1-8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group (P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR (P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR (P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.

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Section: Introductionmentioning

confidence: 99%

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

Giacalone

Rathat

Daurès

et al. 2010

Breast Cancer Res Treat

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“…Reconstructions that are subsequently irradiated may have inferior esthetic outcomes and higher complication rates [14]. Also it may pose challenges to optimizing radiotherapy planning and some groups described technical difficulty in delivering PMRT in this subset of patients [15].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Immediate Breast Reconstruction on the Technical Delivery of Postmastectomy Radiotherapy

Aziz¹,

Reyad²,

Kamel³

et al. 2011

J Cel Sci Therapy

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Purpose: To quantify the impact of immediate reconstruction on radiotherapy planning after modified radical mastectomy & to study radiotherapy complications. Patients and methods:After surgery, patients submitted to adjuvant radiotherapy with irradiation technique assessment using a semi-quantitative score evaluating the design of radiation fields including five objectives: breadth of chest wall coverage, homogeneity, minimization of lung irradiation, avoidance of heart and Dmax. with assessment of radiation morbidity.Results: 30 patients were enrolled at Bristol Haematology & Oncology Centre (UK) and Oncology Department, Ain Shams University hospitals (Egypt) between November 2007 and November 2009, with a mean follow up of 14.4 months. 27 patients (90%) had Latissimus Dorsi flaps & 3 (10%) had TRAM flap. The analysis revealed compromise in 24% of the plans; all are moderate compromise. Reconstruction was noticed to compromise chest wall coverage in 27%. Dose homogeneity, Dmax. and minimizing irradiated lung and heart were not affected. Compromises were more common in left side while complications were grades 1 and 2 without major morbidities. Conclusion:Immediate reconstruction may limit treatment planning of postmastectomy radiotherapy, particularly in providing adequate chest wall coverage; so candidate patients for immediate reconstruction should be aware that the presence of the reconstructed breast could cause technical difficulties.

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“…The main indication criteria for PMRT are: larger tumor (T3), positive resection margins and positive regional lymph nodes (16). Although the appropriate delivery of radiation to the chest wall following reconstrucion have been sporadically issued (17), the quality of radiotherapy does not seem to be substantially compromised by the presence of reconstructed breast. However, there has been a clear evidence that PMRT increases the surgical complication rate of the reconstruction and worsens its longterm outcomes regardless of the method used (18,19,20).…”

Section: Discussionmentioning

confidence: 99%

Immediate Breast Reconstructions in Breast Cancer Patients

Hýža

Veselý

Dražan

et al. 2008

Polish Journal of Surgery

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3In mastectomy women an immediate breast reconstruction has become a real option over the past several years. Like many other reconstructive procedures, breast reconstruction aims not only to restore body form and anatomy, but also to improve quality of life and emotional well-being. The aim of the study was to review the cases of mastectomies and immediate breast reconstructions within 8 years and propose a mastectomy-reconstructive protocol to be used and evaluated for the future. Material and methods. Since January 2001, 39 patients of average age 43.9 years underwent mastectomy for early breast cancer and subsequent immediate reconstruction. Patients had either the breast reconstructed with an abdominal flap at the time of mastectomy, or they had a two stage reconstruction with the expander placed during mastectomy procedure and subsequent silicone-gel implant placement. The retrospective chart review of the records of patients with diagnosis of breast cancer were reviewed for histology, tumor size and technique of reconstruction used. Based on the pictures of postoperative results and the chart review, the reconstructive protocol was proposed. Results. The number of patients having immediate reconstruction has significantly increased over the past three years compare to previous period form 2001 till 2005. Majority of the patients were treated for early breast cancers (DCIS -ductal carcinoma in situ or invasive cancer smaller than 2 cm). The vital tissue was used for the reconstruction in 27 patients(71%). Silicone gel implant/implants were used for reconstruction in 11(29%) patients. 23 reconstructions was bilateral for the diagnosis of high oncological risk of contralateral breast parenchyma. Best results were achieved in patients with bilateral breast reconstructions having skin sparing or nipple sparing mastectomy and not having postmastectomy radiation therapy. Conclusions.The immediate breast reconstruction seems to be a reasonable solution for many patients having mastectomy for early breast cancer, smaller than 2 cm and negative sentinel node biopsy (low risk for postmastectomy radiation therapy). We prefer skin sparing or nipple sparing mastectomy if possible. The reconstruction with abdominal tissue results in a good and time-stable results in majority of the cases.

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Immediate Breast Reconstruction can Impact Postmastectomy Irradiation

Abstract: Immediate breast reconstruction may impose limitations on the treatment planning of postmastectomy radiotherapy, particularly in regard to providing broad coverage of the chest wall and IMC region while avoiding excess exposure of the heart and lung.

Cited by 82 publications

References 49 publications

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study

The Impact of Immediate Breast Reconstruction on the Technical Delivery of Postmastectomy Radiotherapy

Immediate Breast Reconstructions in Breast Cancer Patients

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