Postmastectomy radiation therapy and recommendations for immediate breast reconstruction in women with stage II breast cancer

Abstract

Recent developments in management have demonstrated superior local-regional control, disease-free survival, and overall survival in node-positive breast cancer patients with the addition of postmastectomy radiation therapy (PMRT) to mastectomy and chemotherapy. Consequently, PMRT use in patients with stage II breast cancer is increasing. However, it is difficult to predict presence or extent of axillary lymph node involvement before mastectomy. There are two potential problems with performing an immediate breast reconstruction in patients requiring PMRT. First, PMRT may adversely affect the aesthetic outcome of an immediate breast reconstruction. Second, immediate breast reconstruction may interfere with PMRT delivery. With a delayed-immediate approach, however, patients who do not require PMRT may achieve aesthetic outcomes similar to those with immediate reconstruction. In patients requiring PMRT, delayed-immediate breast reconstruction may avoid potential aesthetic and radiation delivery problems after immediate breast reconstruction. Increased PMRT use in early-stage breast cancer requires improved communication among the medical oncologist, radiation oncologist, breast surgeon, and plastic surgeon during treatment planning.