Principles and consequences of radiotherapy for breast reconstruction

Use of postmastectomy radiotherapy (PMRT) has increased over time. The timing and sequencing of radiotherapy in the context of breast reconstruction remain controversial. Immediate breast reconstruction has several psychological, economic, and social advantages, but, by altering the chest wall anatomy, may complicate delivery of PMRT and increase the risk of complications and impaired cosmesis. Delayed breast reconstruction can be challenging, and has the difficulty of operating in previously irradiated fields. A modern radiotherapy approach is needed to minimize the risk of complications. In a PMRT setting, the overall complication rate increases compared with that for nonirradiated patients, irrespective of whether breast reconstruction is performed before or after radiotherapy. Autologous tissue appears to handle PMRT better than allogeneic tissue and is the favorite choice for patients who are candidate to receive PMRT or who have had previous radiotherapy. Many factors are identified as significant predictors of outcome. Despite the rates of complications and reconstruction failure, aesthetic and general satisfaction are generally high.