Radiotherapy and Implant-Based, Two-Stage Breast Reconstruction

Abstract

One-stage and two-stage reconstructions are the major approaches to implant-based breast reconstruction in use today and chest wall irradiation is becoming increasingly common for mastectomy patients who have opted for immediate breast reconstruction with tissue expanders and implants. The optimal approach for such patients has not yet been defined. Although most reconstructive surgeons agree that breasts reconstructed with autologous tissue tend to fare better than breasts reconstructed with implants in patients who have received or will receive postmastectomy radiation therapy, reconstruction with autologous tissue is not always feasible or desired. The debate continues as to whether to perform the second stage (placement of the permanent implant) of two-stage implant-based reconstruction before or after postmastectomy radiation therapy, and many strategies can be used in order to reduce complication rates and optimize aesthetic outcomes in implant-based breast reconstruction for irradiated patients.