Impacto da radioterapia adjuvante no resultado cosmético da reconstrução mamária imediata com retalho TRAM

Abstract

Impact of adjuvant radiotherapy on the cosmetic outcome of immediate breast reconstruction performed using a transverse rectus abdominis myocutaneous flap Impact of adjuvant radiotherapy on the cosmetic outcome of immediate breast reconstruction performed using a transverse rectus abdominis myocutaneous flap Impacto da radioterapia adjuvante no resultado cosmético da reconstrução mamária imediata com retalho TRAM ABSTRACT Background: The outcome of adjuvant radiotherapy performed after breast reconstruction using autologous flaps is controversial. In this study, we aimed to assess whether postoperative radiotherapy would induce volumetric and cosmetic changes after immediate breast reconstruction performed using a transverse rectus abdominis myocutaneous (TRAM) flap. Methods: We evaluated 25 patients who were previously diagnosed with breast cancer and underwent post-mastectomy autologous reconstruction with a pedicled TRAM flap follo wed by adjuvant radiotherapy. Late aesthetic results were recorded starting 6 months after the completion of a full course of radiotherapy. Results: The average patient age was 42.2 years (range, 30-53 years). Two (8%) complete flap losses occurred due to massive fat necrosis. Two (8%) patients exhibited flap contracture and volume loss, whereas skin changes were observed in 52% of patients. Most of the patients (84%), however, had no sig nificant initial flap volume loss, contour distortion, or flap contraction. Conclusions: The cosmetic result obtained in the present study by immediate breast reconstruction performed using an irradiated TRAM flap was satisfactory compared to the data described in the literature. These findings suggest that the flap contours may be distorted by contraction and that significant volume losses can be observed in patients who may be candidates for TRAM flap reconstruction and require post-mastectomy adjuvant radiotherapy. Thus, in these circumstances, late complications due to postoperative irradiation should be considered.

Prevalence of dermatological complaints in patients undergoing treatment for breast cancer

“…The most reported complaint was erythema of the breast, followed by hyperpigmentation, present in 73.2% and 64% of the patients treated with radiation, respectively, what is in contrast with another study that assessed the effects of post-operatory radiotherapy, in which hyperpigmentation and fibrosis were detected in 52% of the patients. 30 The study by Hu et al 29 also demonstrated hyperpigmentation on the breast of women treated with radiotherapy, as well as xerosis, complaints reported in 20.9% of the irradiated patients in this study. This is due to the fact that the skin, an organ that is continually renewed, is highly susceptible to radiation injury, leading to acute and late cutaneous changes, and therefore, radiotherapy is associated to a higher prevalence of those ( p = 0.011).…”