Radiation and breast reconstruction: Algorithmic approach and evidence-based outcomes

Abstract

Postmastectomy radiation (PMRT) in the setting of immediate breast reconstruction has been associated with increased complications and poorer aesthetic outcomes for both autologous and implant reconstructions. Many centers have attempted to mitigate the deleterious effects associated with radiation by implementing an algorithmic approach to breast reconstruction. Although the literature regarding the optimal timing of radiotherapy and breast reconstruction remains controversial, reported outcomes following various algorithms have been encouraging and warrant further consideration. J. Surg. Oncol. 2016;113:906-912. © 2016 Wiley Periodicals, Inc.

Own Experience of Laser Therapy for the Prevention and Treatment of Early and Late Radiation-Induced Skin Injuries in Patients With Breast Cancer After Simultaneous Reconstructive Plastic Surgery

“…Сегодня это особенно актуально у данной категории больных, так как на протяжении последних 20 лет прослеживается четкая тенденция к росту числа одномоментных реконструктивно-пластических опе-раций [9], которые связаны с большим риском возник-новения осложнений. Например, по данным B. ElSabawi и соавт., выявляется до 40 % осложнений, приводящих к удалению реконструированной молоч-ной железы (МЖ), среди причин возникновения кото-рых (хирургическое лечение, проведенная химиотера-пия, сопутствующие заболевания) называют и лучевую терапию [10]. В связи с этим существует необходимость изучения и использования лекарственных и физиче-ских средств профилактики и лечения ранних и позд-них лучевых повреждений у больных РМЖ, которым предполагается или уже выполнена реконструктивно-пластическая операция с планированием послеопера-ционной лучевой терапии.…”

Impact of different type of cancer treatment on the effectiveness of breast reconstruction

“…On the other hand, radiotherapy is associated with increased complications and poorer aesthetic outcomes following both autologous tissue and implant-based breast reconstructions (19)(20)(21). The long-term effects of radiation therapy include microvascular damage, fibroblast dysfunction, decreased and disorganized collagen deposition, decreased angiogenesis and decreased wound tensile strength.…”

“…Again, the timing of the reconstructive procedure remains controversial. Delayed or delayed-immediate autologous reconstructions are proposed as an effective options for reducing the risk of radiationinduced contour-irregularities (11,19). Some studies suggest 12 months interval as a safe period after primary surgical treatment, after which significant decrease in rate of complications is observed (26).…”

Microsurgical Flaps in Nipple Sparing Mastectomy: Surgical Techniques and Aesthetic Principles

“…In these patients, special consideration must be given to the type of reconstruction that is performed, as radiation can result in significant distortion of the breast tissue [20]. Although autologous reconstruction tolerates PMRT better than implant-based reconstruction, the incidence of contracture, fat necrosis, hyperpigmentation, and other flap-related complications remains high, leading to breast asymmetry and suboptimal aesthetic outcomes [21,22].…”

“…Although delayed reconstruction can be performed in these patients, aesthetic results are superior with immediate reconstruction due to the preservation of the skin envelope. As a solution to the need for revision procedures in patients who desire autologous reconstruction but need PMRT, delayed-immediate autologous reconstruction can be performed, during which a tissue expander is inserted to maintain the breast pocket following mastectomy and replaced with autologous tissue after radiation therapy has been completed [20]. Regardless, adjuvant therapy has a negative effect on surgical aesthetic outcomes [23].…”