Main Article Content
Post-mastectomy radiation therapy, PMRT, Breast radiation, Breast reconstruction, Radiation changes
Background: Post-mastectomy radiation therapy (PMRT) is a key component in managing breast cancer with increased potential for locoregional recurrence. Breast reconstruction has evolved to include various techniques that can be categorized according to the type of reconstruction (implant-based versus autologous reconstruction), and the timing of reconstruction (one versus two-step techniques).
Methods/Results: This review article aims to provide a digestible summary of PMRT in the context of breast reconstruction by summarizing salient existing literature with a focus on considerations of the plastic surgeon. The main findings summarized in this review include the technique and timing of breast reconstruction, how breast reconstruction can affect radiation delivery, and the type of reconstruction. Within implant-based reconstruction, existing data on the location of the implant in the context of PMRT and PMRT delivery to the tissue expander versus permanent implant are reviewed. Each consideration may alter the probability of successful reconstruction and patient satisfaction.
Conclusion: It is essential for the multidisciplinary breast cancer team to have knowledge of the various reconstructive options, and to understand the safety and comparative effectiveness of staged reconstruction in the setting of PMRT. Additionally, one must consider that reconstructive procedures may have implications on the timely administration of PMRT. This review serves as a reference for members of the oncologic care team when discussing reconstructive options with patients who will receive PMRT as part of their treatment plan.
2. Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109(7):2265-74.
3. Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26(1):17-9.
4. Yoon AP, Qi J, Brown DL, Kim HM, Hamill JB, Erdmann-Sager J, et al. Outcomes of immediate versus delayed breast reconstruction: Results of a multicenter prospective study. Breast. 2018;37:72-9.
5. Surgeons ASoP. Plastic Surgery Statistics Report 2019 [Available from:https://www.plasticsurgery.org/ documents/News/Statistics/2019/plastic-surgery-statistics-full-report-2019.pdf.
6. Wilkins EG, Hamill JB, Kim HM, Kim JY, Greco RJ, Qi J, et al. Complications in Postmastectomy Breast Reconstruction: One-year Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study. Ann Surg. 2018;267(1):164-70.
7. Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 2001;108(1):78-82.
8. Spear SL, Ducic I, Low M, Cuoco F. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg. 2005;115(1):84-95.
9. Clarke-Pearson EM, Chadha M, Dayan E, Dayan JH, Samson W, Sultan MR, et al. Comparison of irradiated versus nonirradiated DIEP flaps in patients undergoing immediate bilateral DIEP reconstruction with unilateral postmastectomy radiation therapy (PMRT). Ann Plast Surg. 2013;71(3):250-4.
10. Taghizadeh R, Moustaki M, Harris S, Roblin P, Farhadi J. Does post-mastectomy radiotherapy affect the outcome and prevalence of complications in immediate DIEP breast reconstruction? A prospective cohort study. J Plast Reconstr Aesthet Surg. 2015;68(10):1379-85.
11. Kronowitz SJ, Lam C, Terefe W, Hunt KK, Kuerer HM, Valero V, et al. A multidisciplinary protocol for planned skin-preserving delayed breast reconstruction for patients with locally advanced breast cancer requiring postmastectomy radiation therapy: 3-year follow-up. Plast Reconstr Surg. 2011;127(6):2154-66.
12. Crisera CA, Chang EI, Da Lio AL, Festekjian JH, Mehrara BJ. Immediate free flap reconstruction for advanced-stage breast cancer: is it safe? Plast Reconstr Surg. 2011;128(1):32-41.
13. Kahila MMJ, K.R.; Whitaker, T.J.; Corbin, K.S., Park, S.S.; Yan, E.S.; Lemaine, V.; Jacobson, S.R.; Boughey, J.C.; Mutter, R.W. Immediate Breast Reconstruction Does Not Compromise the Quality of Postmastectomy Radiation Therapy (PMRT). Internation Journal of Radiation Oncology. 2016;96(2).
14. Shammas RL, Ren Y, Thomas SM, Hollenbeck ST, Greenup RA, Blitzblau RC. Immediate Breast Reconstruction Allows for the Timely Initiation of Postmastectomy Radiation Therapy. Plast Reconstr Surg. 2019;144(3):347e-57e.
15. Albornoz CR, Bach PB, Mehrara BJ, Disa JJ, Pusic AL, McCarthy CM, et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131(1):15-23.
16.Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105(3): 930-42.
17. Sbitany H, Gomez-Sanchez C, Piper M, Lentz R. Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits. Plast Reconstr Surg. 2019;143(1):10-20.
18. Elswick SM, Harless CA, Bishop SN, Schleck CD, Mandrekar J, Reusche RD, et al. Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy. Plast Reconstr Surg. 2018;142(1):1-12.
19. Cattelani L, Polotto S, Arcuri MF, Pedrazzi G, Linguadoca C, Bonati E. One-Step Prepectoral Breast Reconstruction With Dermal Matrix-Covered Implant Compared to Submuscular Implantation: Functional and Cost Evaluation. Clin Breast Cancer. 2018;18(4):e703-e11.
20. Sinnott CJ, Persing SM, Pronovost M, Hodyl C, McConnell D, Ott Young A. Impact of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction. Ann Surg Oncol. 2018;25(10): 2899-908.
21. Sobti N, Weitzman RE, Nealon KP, Jimenez RB, Gfrerer L, Mattos D, et al. Evaluation of capsular contracture following immediate prepectoral versus subpectoral direct-to-implant breast reconstruction. Sci Rep. 2020;10(1):1137.
22. Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg. 2004;113(3):877-81.
23. Cordeiro PG, Albornoz CR, McCormick B, Hu Q, Van Zee K. The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction: an analysis of long-term surgical outcomes, aesthetic results, and satisfaction over 13 years. Plast Reconstr Surg. 2014;134(4):588-95.
24. Cordeiro PG, Albornoz CR, McCormick B, Hudis CA, Hu Q, Heerdt A, et al. What Is the Optimum Timing of Postmastectomy Radiotherapy in Two-Stage Prosthetic Reconstruction: Radiation to the Tissue Expander or Permanent Implant? Plast Reconstr Surg. 2015;135(6):1509-17.
25. Toyserkani NM, Jorgensen MG, Tabatabaeifar S, Damsgaard T, Sorensen JA. Autologous versus implant-based breast reconstruction: A systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg. 2020;73(2):278-85.
26. Tsoi B, Ziolkowski NI, Thoma A, Campbell K, O'Reilly D, Goeree R. Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients: a systematic review and meta-analysis. Plast Reconstr Surg. 2014;133(2): 234-49.
27. Hangge PT, Jogerst K, Mohsen A, Kosiorek H, Cronin PA, Stucky CH, et al. Making an informed choice: Which breast reconstruction type has the lowest complication rate? Am J Surg. 2019;218(6):1040-5.
28. Mirzabeigi MN, Smartt JM, Nelson JA, Fosnot J, Serletti JM, Wu LC. An assessment of the risks and benefits of immediate autologous breast reconstruction in patients undergoing postmast-ectomy radiation therapy. Ann Plast Surg. 2013; 71(2):149-55.
29. Williams JK, Carlson GW, Bostwick J, 3rd, Bried JT, Mackay G. The effects of radiation treatment after TRAM flap breast reconstruction. Plast Reconstr Surg. 1997;100(5):1153-60.
30. Giacalone PL, Rathat G, Daures JP, Benos P, Azria D, Rouleau C. New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat. 2010;122(2):439-51.
31. McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127-35.
32. McGuire SE, Gonzalez-Angulo AM, Huang EH, Tucker SL, Kau SW, Yu TK, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys. 2007;68(4):1004-9.
33. Huang EH, Tucker SL, Strom EA, McNeese MD, Kuerer HM, Buzdar AU, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol. 2004;22(23):4691-9.