Reconstructive breast surgery following mastectomy and adjunctive radiation therapy

Abstract

With modern radiation, surgical therapy, and surgical reconstructive techniques, it is now possible to give adequate treatment for breast cancer and to reconstruct the breast as well, using a silicone implant prosthesis. Twelve mastectomies and reconstructions were performed on 8 patients. Seven of these had pre- or postoperative irradiation to one breast region, and 1 patient received irradiation to both breast areas. The clinical staging of patients with combined irradiation and surgery was Stage I—3 cases; Stage II—4 cases; and Stage III—1 case. Primary surgical procedures consisted of modified radical mastectomy for ten breast lesions and simple mastectomy for two others. Megavoltage radiotherapy was administered with a CO-60 Unit. Pre-operative irradiation of 4000 rads to the breast, chest wall, and regional lymphatics was given to 3 patients. Postoperative radiation therapy of 5000 rads to the chest wall and 4400–5000 rads to the regional lymphatics was given to 5 other patients, one of whom received bilateral irradiation. Adjunctive chemotherapy was employed in 5 patients with interruption during the period of implant surgery. Reconstructive surgery was performed 5 months to 14 months after irradiation in 7 patients and 5 1/2 years later in one patient. The procedure was a single stage operation with placement of a silicone prosthesis under the pectoralis muscle. No significant morbidity was encountered from radiotherapy, chemotherapy, or from the surgical procedures. Healing of surgical wounds after implantation was uncomplicated. Cosmetic results have been good. All patients are alive and well, 8 months to 6 1/2 years postirradiation and three months to three years post-breast reconstruction. Results to date have been most gratifying.