Coordinating treatment
Radiotherapy can change reconstructive outcomes.
Post-mastectomy radiotherapy may be recommended to reduce the risk of cancer returning in the chest wall or regional lymph nodes.
The recommendation is based on cancer-related factors. Reconstruction should be planned around that recommendation rather than used to avoid it.
How radiotherapy affects tissue
Radiotherapy may cause progressive changes in skin and soft tissue. These can include firmness, reduced elasticity, discoloration, swelling, altered blood supply and delayed healing.
Some changes appear during treatment. Others develop gradually over months or years.
Implant reconstruction
In implant reconstruction, radiotherapy may increase the risk of capsular contracture, displacement, pain, poor shape, infection and reconstruction failure.
Patients should ask whether radiotherapy will be delivered to an expander, a permanent implant or the reconstructed chest before implant exchange.
Autologous reconstruction
Autologous tissue can also develop firmness, volume change, fat necrosis or asymmetry after radiotherapy.
Some teams prefer delayed autologous reconstruction after radiotherapy. Others may recommend immediate reconstruction in selected cases. The decision depends on the anticipated radiation plan and patient factors.
What Korean nationwide data examined
A Korean nationwide study analyzed 4,669 patients who underwent post-mastectomy radiotherapy and breast reconstruction between 2015 and 2020.
The investigators compared serious complications according to radiotherapy fractionation and reconstruction procedure.
The study provides large-scale real-world information. It does not contain every clinical detail required to select an individual reconstruction method.
Questions for the multidisciplinary team
- How likely is post-mastectomy radiotherapy?
- Can that likelihood be estimated before surgery?
- Which tissues and lymph-node regions would be treated?
- How might radiation affect the proposed reconstruction?
- Would reconstruction be immediate, staged or delayed?
- What is the backup plan if final pathology changes the recommendation?
- Who will follow late radiation-related complications?