Options in Reconstructing the Irradiated Breast

Abstract

As radiation therapy becomes more prevalent in the treatment of breast cancer, more patients requesting breast reconstruction for mastectomy defects will have a history of radiation therapy. A retrospective chart review study was performed of a single surgeon's 5-year experience with reconstruction of the irradiated breast. Sixty-six primary patients and 13 secondary patients were treated over a 5-year period (2001-2005). Of the 66 primary patients, 25 (38 percent) presented for reconstruction after recurrence following prior breast conservation therapy: 12 had prosthetic based reconstructions (with or without a latissimus flap) and 13 had autologous reconstructions. Twenty-five patients (38 percent) presented after mastectomy followed by radiation therapy: six had prosthetic-based constructions and 19 had autologous reconstructions. Twelve patients (18 percent) had their reconstructions performed before radiation therapy: nine had implant-based reconstructions and three had autologous reconstructions. Four patients (6 percent) presented for corrections of breast conservation therapy deformities. One hundred seventy-five total operations were performed for the primary patients, with an average of 2.65 operations per patient. Thirteen patients were treated secondarily after previous reconstruction at other institutions with a variety of reconstruction methods used. Twenty-eight total operations were performed for the secondary patients, with an average of 2.2 operations per patient. Capsular contracture rates using the prosthetic score are reported. Because of the variability of presentation of the irradiated breast cancer patient, there is no one method of reconstruction ideally suited for all irradiated patients. In this 5-year review, the authors found that with careful patient evaluation and selection, good results can be attained regardless of reconstructive method.