Postmastectomy radiation therapy and immediate autologous breast reconstruction: Integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery

Danielle H. Rochlin, Ah Reum Jeong, Leah Goldberg, Timothy Harris, Kriti Mohan, Stella Seal, Joe Canner, Justin M. Sacks

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background and Objectives: The effect of postmastectomy radiation therapy (PMRT) on immediately reconstructed abdominal wall-based tissue remains imprecisely defined. We evaluated evidence from all fields involved in care of the breast cancer patient in order to advance a unified recommendation regarding this therapeutic sequence. Methods: We performed a MEDLINE and manual reference search to identify studies of PMRT with immediate autologous breast reconstruction. Inclusion criteria required studies to describe patients, flaps, and complication rates. Analyses were based on a random effects model. Surgical and radiation oncology literature was reviewed. Results: Eleven retrospective studies of 337 patients with an average follow-up of 18-60 months (out of 268 patients) were selected for inclusion. Overall rates of fat necrosis, revisional surgery, volume loss, and fibrosis/contracture ranged from 16.9% to 35.4%. One out of 260 patients experienced total flap loss. There was an increased probability of fat necrosis in the irradiated breast (OR=3.13, 95% CI=1.42-6.89, P=0.005) among three studies with non-irradiated controls. Five studies evaluated aesthetics with variable outcomes. Conclusions: There is mixed evidence for the utility of PMRT with immediate autologous abdominal wall breast reconstruction. Further investigation requires prospective studies with collaboration among surgical oncologists, radiation oncologists, and plastic surgeons.

Original languageEnglish (US)
Pages (from-to)251-257
Number of pages7
JournalJournal of Surgical Oncology
Volume111
Issue number3
DOIs
StatePublished - Mar 1 2015

Keywords

  • Autologous tissue
  • Breast reconstruction
  • Complications
  • Radiotherapy

ASJC Scopus subject areas

  • Surgery
  • Oncology

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