XRT On Reconstructed Breast

Types of reconstruction:

• Implant-based
  • Simpler procedure
  • No donor site morbidity
  • Appropriate for those who don’t have the volume of donor site
  • A tissue expander is placed between the pectoralis major, when full expansion is achieved, replaced with an implant.
  • Most women treated with postmastectomy radiation who undergo implant-based reconstruction require an immediate reconstruction procedure. This is because after radiation the normal tissues are less compliant and tissue expanders are often unsuccessful and may cause rib fractures and other injuries.
• Autologous tissue reconstruction
  • Immediate
• Benefits:
  • accompanied by a skin-sparing mastectomy → preserves a significant component of the normal breast skins ⇒preserves the natural inframammary sulcus and other skin envelopes.
  • Better Cosmesis
• Downsides(twofold)
  1. XRT has long-term adverse effects
     1. Particularly implant-based reconstruction
  2. Reconstruction has a negative effect on the design and delivery of radiation treatment fields.

Options for timing:

1. Immediate (done at the time of mastectomy)
2. Delayed (done after completion of radiation)

Effects of Radiation on Reconstruction

• The majority of patients who undergo an immediate reconstruction and require postmastectomy radiation will have an aesthetic change as a consequence of treatments.
• Implant-based reconstruction
  • High rates of late contraction, fibrosis, implant fixation, and a poor aesthetic outcome. Many of these changes begin 6 months after treatment and insidiously progress over time.
• Immediate autologous tissue reconstruction
  • The effects, while common, may be less severe than implant-based approaches

Complication due to XRT on immediate reconstructed breast > delayed

• in immediate group → additional flap to improve aesthetics.

• Overinflated tissue expanders can cause significantly sloping contours at field junction between chest wall and internal mammary fields and between chest wall and supraclavicular/axillary apex fields ⇒ compromises should be made.