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Review
. 2012 Aug;1(2):119-27.
doi: 10.3978/j.issn.2227-684X.2012.05.02.

Radiotherapy and breast reconstruction: oncology, cosmesis and complications

Affiliations
Review

Radiotherapy and breast reconstruction: oncology, cosmesis and complications

Warren M Rozen et al. Gland Surg. 2012 Aug.

Abstract

Breast reconstruction plays a highly important role in the management of patients with breast cancer, from a psycho-social and sexual stand-point. Given that immediate breast reconstruction does not impair the oncologic safety of breast cancer management, with no increase in local recurrence rates, and no delays in the initiation of adjuvant chemotherapy or radiotherapy, the need to balance cosmesis in reconstruction with the oncologic needs of breast cancer patients is no more evident than in the discussion of radiotherapy. Radiotherapy is essential adjuvant therapy in the treatment of breast cancer, with the use of adjuvant radiotherapy widely shown to reduce local recurrence after both partial and total mastectomy and shown to prolong both disease-free and overall survival in patients with nodal disease. In the setting of breast reconstruction, the effects of radiotherapy are potentially two-fold, with consideration required of the impact of breast reconstruction on the administration of and the initiation of radiotherapy, as well as the effects of radiotherapy on operative complications and cosmetic outcome following immediate breast reconstruction. The current editorial piece aims to analyze this balance, contrasting both autologous and implant-based reconstruction. The literature is still evolving as to the relative role of autologous vs. alloplastic reconstruction in the setting of radiotherapy, and the more recent introduction of acellular dermal matrix and other compounds further complicate the evidence. Fat grafting and evolving techniques in breast reconstruction will herald new discussions on this front.

Keywords: Implant; adjuvant therapy; breast reconstruction; radiation; reconstructive surgery.

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Figures

Figure 1
Figure 1
Skin and flap contracture in a deep inferior epigastric artery (DIEA) perforator flap, in which postoperative radiotherapy was administered to the supero-medial pole of the breast. Marked skin changes, asymmetry, and nipple displacement are evident. Reproduced with permission from: Rozen WM, Ashton MW, Taylor GI. Defining the role for autologous breast reconstruction post-mastectomy: the social and oncological implications. Clin Breast Cancer 2008;8:134-42.
Figure 2
Figure 2
Skin and scar retraction in the setting of adjuvant radiotherapy following partial mastectomy. Reproduced with permission from: Rozen WM, Ashton MW, Taylor GI. Defining the role for autologous breast reconstruction post-mastectomy: the social and oncological implications. Clin Breast Cancer 2008;8:134-42.
Figure 3
Figure 3
Skin and nipple retraction in the setting of adjuvant radiotherapy following partial mastectomy. Reproduced with permission from: Rozen WM, Ashton MW, Taylor GI. Defining the role for autologous breast reconstruction post-mastectomy: the social and oncological implications. Clin Breast Cancer 2008;8:134-42.
Figure 4
Figure 4
A. smooth saline implant; B. smooth, cohesive silicone gel implant; C. saline tissue expander. Images supplied by Mentor (California, USA). Reproduced with permission from: Rozen WM, Rajkomar A, Anavekar N and Ashton MW. Breast Reconstruction Post-Mastectomy: a History in Evolution. Clin Breast Cancer 2009;9:145-54.

References

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