Radiation therapy and breast reconstruction: Outcomes and complications in our experience

Abstract

Purpose The impact of adjuvant therapy on the surgical outcomes following breast reconstruction is poorly understood. The purpose of this work is to evaluate surgical outcomes following autologous and prosthetic reconstruction in the setting of PMRT and adjuvant chemotherapy. Material and method From May 2015 to July 2015, we analyzed acute, late toxicity and cosmetic results of 76 patients with a median age of 50 ± 10 years undergoing mastectomy with immediate reconstruction with prosthesis (79.7%), autologous technique (7.2%) or expander-implant (13%) following adjuvant radiotherapy. Twenty-four patients underwent to nac- sparing mastectomy, 10 of which with periareolar pexy. Thirty-one patients underwent to skin reducing mastectomy and 5 patients to skin sparing mastectomy. The radiotherapy dose was 50 Gy to chest wall and supraclavicular limphnodes. Results With a median follow-up of 25 ± 24 months utilizing RTOG toxicity scale, we observed a grade I acute toxicity in 74.6% of patients, grade II in 6% of patients while in 19.4% of patients, any sign of toxicity was not observed. Late toxicity was not observed in 68.7% of patients while in 28.4% of patients a grade I late toxicity was noted. No post-operative complications was observed in 62.3% of patients while in 15.9% a capsular contracture was responsible in 20.3% of patients of explantation of prosthesis. None of patients developed post-operative skin ulcers. Cosmetic results was analyzed with Harvard Scale and was excellent in 4.5% of patients, good in 32.8%, fair in 16.4% and poor in 46.3%. The χ 2 test showed no correlation between early or late toxicity or cosmetics results with type of surgery ( P > 0.1). Univariate analysis showed no relationship between cosmetic result and age ( P > 0.13). Conclusion Our experiences is limited but confirm that adjuvant radiotherapy is not controindicated when reconstructive surgery is expected. The patient must be informed about the possible radiation sequelae.