Radiotherapy and breast reconstruction: a narrative review

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: The practice of breast reconstruction in the setting of radiation therapy has increased profoundly over the past years which sparked a controversy regarding the optimal method and timing of reconstruction in this subgroup of patients. Radiation therapy although essential for locoregional control of breast cancer adds significantly to the complexity of breast reconstruction. The optimal form and timing of reconstruction has been a topic of debate. Like in all cases of breast reconstruction, the reconstruction can be autologous or prosthetic, the question is in the setting of radiation therapy is there one superior to the other. Should the reconstruction be done in one stage or two stages? Should we attempt immediate reconstruction or is it more favorable to delay the reconstruction all together? Another important consideration is the timing of the radiation with respect to the permanent reconstruction. Because of its effects on tissues, radiation therapy affects both the short term and long-term outcomes of the reconstruction. Patients receiving radiotherapy, regardless of the reconstructive technique, have higher rates of infections, flap failures, implant exposure, loss of the reconstruction and capsular contracture. They also have lower patient satisfaction with the cosmetic result. In this review we will address this topic and look into the recent evidence on the ideal way to integrate these two entities together.