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Review
. 2025 Apr;201(4):353-367.
doi: 10.1007/s00066-024-02334-3. Epub 2025 Jan 9.

Implant-based reconstruction and adjuvant radiotherapy in breast cancer patients-current status and DEGRO recommendations

M D Piroth  1 , D Krug  2 , R Baumann  3 , V Strnad  4 , K Borm  5 , S Combs  5   6   7 , S Corradini  8 , M N Duma  9   10 , J Dunst  11 , G Fastner  12 , P Feyer  13 , R Fietkau  4 , W Harms  14 , T Hehr  15 , J Hörner-Rieber  16 , C Matuschek  17 , C Schmeel  18 , W Budach  16 ; Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)
Affiliations
Review

Implant-based reconstruction and adjuvant radiotherapy in breast cancer patients-current status and DEGRO recommendations

M D Piroth et al. Strahlenther Onkol. 2025 Apr.

Abstract

Purpose: The aim of this review is to give an overview of the results of prospective and retrospective studies using allogenic reconstruction and postmastectomy radiotherapy (PMRT) in breast cancer and to make recommendations regarding this interdisciplinary approach.

Materials and methods: A PubMed search was conducted to extract relevant articles from 2000 to 2024. The search was performed using the following terms: (breast cancer) AND (reconstruction OR implant OR expander) AND (radiotherapy OR radiation). Data from the literature on allogenic breast reconstruction and radiation are presented and discussed in relation to toxicity and cosmesis.

Conclusion and recommendations: Breast reconstruction is also feasible if PMRT is necessary. Patients need to be informed about the relevant risk of capsular fibrosis and implant failure. A planned reconstruction is no reason to forgo PMRT nor is an indication for PMRT a reason to forego implant-based breast reconstruction if desired by the patient. It is important to provide detailed information here to enable shared decision-making. There is still no clear consensus regarding implant-based reconstruction (IBR) and PMRT. However, in clinical practice, both a one-stage (immediate "implant-direct" IBR) procedure with PMRT up to the final implant and a two-stage (immediate-delayed IBR) procedure with PMRT up to the tissue expander (TE) and later exchange of the TE are used; both approaches have their specific advantages and disadvantages. Depending on patient-specific factors and the surgeon's experience and estimates, both IBR procedures are also possible in combination with PMRT. When using a TE/implant approach, completing skin stretching by adequately filling the expander before PMRT may be favorable. This approach is particularly practical when adjuvant chemotherapy is planned but may lead to postponement of radiotherapy when primary systemic therapy is given. According to the latest data, moderate hypofractionation also appears to be safe in the context of the IBR approach. It is important to have a closely coordinated interdisciplinary approach and to fully inform patients about the increased rate of potential side effects.

Keywords: Breast cancer; Breast reconstruction; Implant-based reconstruction; Mastectomy; Postmastectomy radiotherapy; Radiotherapy.

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Conflict of interest statement

Conflict of interest: D. Krug has received honoraria from Astra Zeneca, best practice onkologie, ESO, ESMO, Gilead, med update, Merck Sharp & Dohme, Novartis, onkowissen, and Pfizer as well as research funding from the Stiftung Deutsche Krebshilfe and Merck KGaA. K. Borm has received Speaker Honoraria from Accuray and Travel Grant from Carl Zeiss. J. Hörner-Rieber reports honoraria and travel reimbursement by Viewray Inc., Pfizer Inc, Sanofi, and AstraZeneca as well as research grants from IntraOP Medical and Varian Medical Systems outside the submitted work. C. Matuschek has received research funding from the Stiftung Deutsche Krebshilfe. M.D. Piroth, R. Baumann, V. Strnad, S. Combs, S. Corradini, M.N. Duma, J. Dunst, G. Fastner, P. Feyer, R. Fietkau, W. Harms, T. Hehr, C. Schmeel, and W. Budach declare that they have no competing interests.

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