Current Status of Postmastectomy Radiation and Breast Reconstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Xiaoqin , WANG Rong , LU Qing ,  LI Hongjiang

Department of Thyroid and Breast Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

LI Hongjiang, Email: lihongjiang@sohu.com

Keywords：

Breast cancer; Postmastectomy radiotherapy; Breast reconstruction; Cosmetic outcome; Comp-lications

Video：

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Objective 　To explore the interaction of postmastectomy radiotherapy （PMRT） and breast reconstruction， and elucidate how to choose the type and timing of breast reconstruction.
Method 　Literatures about PMRT and breast reconstruction were reviewed.
Results 　PMRT might increase the incidence of complications and impair the cosmetic satisfaction of breast reconstruction. Breast reconstruction might also compromise the effect of PMRT.
Conclusions 　In patients who will receive or have already received PMRT， the optimal approach is delayed autologous tissue reconstruction after PMRT. If PMRT appears likely but may not be required at the time of mastectomy，delayed-immediate reconstruction may be considered， or immediate autologous tissue reconstruction may be considered in case of patients awareness of the increased complications and impaired cosmetic outcomes from PMRT.

Citation： YANG Xiaoqin,WANG Rong,LU Qing,LI Hongjiang,.. Current Status of Postmastectomy Radiation and Breast Reconstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(8): 867-871. doi: Copy

1.	Sieber DA， Vandevender DK， Albuquerque KV. Intermeshing breast reconstruction and postmastectomy radiation[J]. Expert Rev Anticancer Ther， 2010， 10(8)：1273-1283.
2.	Rehman MU， Buttar QM， Khawaja MI， et al. An impending cancer crisis in developing countries：are we ready for the cha-llenge?[J]. Asian Pac J Cancer Prev， 2009， 10(4)：719-720.
3.	Taylor ME， Haffty BG， Rabinovitch R， et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast[J]. Int J Radiat Oncol Biol Phys， 2009， 73(4)：997-1002.
4.	Ragaz J， Olivotto IA， Spinelli JJ， et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy：20-year results of the British Columbia randomized trial[J]. J Natl Cancer Inst， 2005， 97(2)：116-126.
5.	Schneider WJ， Hill HL Jr， Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction[J]. Br J Plast Surg， 1977， 30(4)：277-281.
6.	Losken A， Jurkiewicz MJ. History of breast reconstruction[J]. Breast Dis， 2002， 16(16)：3-9.
7.	Cronin TD， Gerow FJ. Augmentation mammaplasty：A new “natural feel” prothesis//Broadbent TRR ed. Transactions of the third international congress of plastic surgery[M]. October 13-18， 1963， Washingtonn D. C， Amsterdam：Excerpta Medica， 1964：41-49.
8.	Radovan C. Breast reconstruction after mastectomy using the temporary expander J]. Plast Reconstr Surg， 1982， 69(2)：195-208.
9.	Becker H. Breast reconstruction using an inflatable breast implant with detachable reservoir J]. Plast Reconstr Surg， 1984， 73(4)：678-683.
10.	Cordeiro PG， Mccarthy CM. A single surgeon’s 12-year experiencewith tissue expander/implant breast reconstruction：partⅠ. A pros-pective analysis of early complications[J]. Plast Reconstr Surg， 2006， 118(4)：825-831.
11.	Cordeiro PG， McCarthy CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction：part Ⅱ. An analysis of long-term complications， aesthetic outcomes， and patient satisfaction[J]. Plast Reconstr Surg， 2006， 118(4)：832-839.
12.	Spear SL， Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast：recent trends and therapeuticimplications[J]. Plast Reconstr Surg， 2000， 105(3)：930-942.
13.	Ascherman JA， Hanasono MM， Newman MI， et al. Implant reconstruction in breast cancer patients treated with radiation therapy[J]. Plast Reconstr Surg， 2006， 117(2)：359-365.
14.	Baschnagel AM， Shah C， Wilkinson JB， et al. Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation[J]. Clin Breast Cancer， 2012， 12(6)：428-432.
15.	Ho A， Cordeiro P， Disa J， et al. Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation[J]. Cancer， 2012， 118(9)：2552-2559.
16.	Tallet AV， Salem N， Moutardier V， et al. Radiotherapy and imme-diate two-stage breast reconstruction with a tissue expander and implant：complications and esthetic results[J]. Int J Radiat OncolBiol Phys， 2003， 57(1)：136-142.
17.	Benediktsson K， Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients：five years of monitoring of a prospective trial[J]. J Plast Reconstr Aesthet Surg， 2006， 59(1)：27-34.
18.	Kronowitz SJ. Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2012， 130(4)：513e-524e.
19.	Spear SL， Mardini S， Ganz JC. Resource cost comparison ofimplant-based breast reconstruction versus TRAM flap breast recons-truction[J]. Plast Reconstr Surg， 2003， 112(1)：101-105.
20.	Blondeel N， Vanderstraeten GG， Monstrey SJ， et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction[J]. Br J Plast Surg， 1997， 50(5)：322-330.
21.	Williams JK， Carlson GW， Bostwick J 3rd， et al. The effects of radiation treatment after TRAM flap breast reconstruction[J]. Plast Reconstr Surg， 1997， 100(5)：1153-1160.
22.	Tran NV， Chang DW， Gupta A， et al. Comparison of immediateand delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2001， 108(1)：78-82.
23.	Rogers NE， Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap[J]. Plast ReconstrSurg， 2002， 109(6)：1919-1924.
24.	Shah C， Kundu N， Arthur D， et al. Radiation therapy following postmastectomy reconstruction：a systematic review[J]. Ann Surg Oncol， 2013， 20(4)：1313-1322.
25.	Durkan B， Amersi F， Phillips EH， et al. Postmastectomy radiation of latissimus dorsi myocutaneous flap reconstruction is well tolerated in women with breast cancer[J]. Am Surg， 2012， 78(10)：1122-1127.
26.	Barry M， Kell MR. Radiotherapy and breast reconstruction：a meta-analysis[J]. Breast Cancer Res Treat， 2011， 127(1)：15-22.
27.	Carlson GW， Page AL， Peters K， et al. Effects of radiation therapyon pedicled transverse rectus abdominis myocutaneous flap breast reconstruction[J]. Ann Plast Surg， 2008， 60(5)：568-572.
28.	Spear SL， Ducic I， Low M， et al. The effect of radiation on pedicled TRAM flap breast reconstruction：outcomes and implications[J]. Plast Reconstr Surg， 2005， 115(1)：84-95.
29.	Makmur L， Lim J， Lim TC. Radiation therapy in immediate breast reconstruction with DIEP flap[J]. Plast Reconstr Surg， 2003， 112(3)：920-921.
30.	Momoh AO， Colakoglu S， de Blacam C， et al. Delayed autologous breast reconstruction after postmastectomy radiation therapy：is there an optimal time?[J]. Ann Plast Surg， 2012， 69(1)：14-18.
31.	Evans GR， Schusterman MA， Kroll SS， et al. Reconstruction and the radiated breast：is there a role for implants?[J]. Plast Reconstr Surg， 1995， 96(5)：1111-1115.
32.	Christante D， Pommier SJ， Diggs BS， et al. Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making[J]. Arch Surg， 2010， 145(9)：873-878.
33.	Kronowitz SJ， Chang DW， Robb GL， et al. Implications of axillarysentinel lymph node biopsy in immediate autologous breast reconstruction[J]. Plast Reconstr Surg， 2002， 109(6)：1888-1896.
34.	Kronowitz SJ， Hunt KK， Kuerer HM， et al. Delayed-immediate breast reconstruction[J]. Plast Reconstr Surg， 2004， 113(6)：1617-1628.
35.	Kronowitz SJ. Delayed-immediate breast reconstruction：technicaland timing considerations[J]. Plast Reconstr Surg， 2010， 125(2)：463-474.
36.	Kronowitz SJ， Kuerer HM. Advances and surgical decision-making for breast reconstruction[J]. Cancer， 2006， 107(5)：893-907.
37.	Motwani SB， Strom EA， Schechter NR， et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy[J]. Int J Radiat Oncol Biol Phys， 2006， 66(1)：76-82.
38.	Chung E， Marsh RB， Griffith KA， et al. Quantifying dose to the reconstructed breast：can we adequately treat?[J]. Med Dosim， 2013， 38(1)：55-59.
39.	Ohri N， Cordeiro PG， Keam J， et al. Quantifying the impact of immediate reconstruction in postmastectomy radiation：a large， dose-volume histogram-based analysis[J]. Int J Radiat Oncol Biol Phys， 2012， 84(2)：e153-e159.

1. Sieber DA， Vandevender DK， Albuquerque KV. Intermeshing breast reconstruction and postmastectomy radiation[J]. Expert Rev Anticancer Ther， 2010， 10(8)：1273-1283.
2. Rehman MU， Buttar QM， Khawaja MI， et al. An impending cancer crisis in developing countries：are we ready for the cha-llenge?[J]. Asian Pac J Cancer Prev， 2009， 10(4)：719-720.
3. Taylor ME， Haffty BG， Rabinovitch R， et al. ACR appropriateness criteria on postmastectomy radiotherapy expert panel on radiation oncology-breast[J]. Int J Radiat Oncol Biol Phys， 2009， 73(4)：997-1002.
4. Ragaz J， Olivotto IA， Spinelli JJ， et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy：20-year results of the British Columbia randomized trial[J]. J Natl Cancer Inst， 2005， 97(2)：116-126.
5. Schneider WJ， Hill HL Jr， Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction[J]. Br J Plast Surg， 1977， 30(4)：277-281.
6. Losken A， Jurkiewicz MJ. History of breast reconstruction[J]. Breast Dis， 2002， 16(16)：3-9.
7. Cronin TD， Gerow FJ. Augmentation mammaplasty：A new “natural feel” prothesis//Broadbent TRR ed. Transactions of the third international congress of plastic surgery[M]. October 13-18， 1963， Washingtonn D. C， Amsterdam：Excerpta Medica， 1964：41-49.
8. Radovan C. Breast reconstruction after mastectomy using the temporary expander J]. Plast Reconstr Surg， 1982， 69(2)：195-208.
9. Becker H. Breast reconstruction using an inflatable breast implant with detachable reservoir J]. Plast Reconstr Surg， 1984， 73(4)：678-683.
10. Cordeiro PG， Mccarthy CM. A single surgeon’s 12-year experiencewith tissue expander/implant breast reconstruction：partⅠ. A pros-pective analysis of early complications[J]. Plast Reconstr Surg， 2006， 118(4)：825-831.
11. Cordeiro PG， McCarthy CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction：part Ⅱ. An analysis of long-term complications， aesthetic outcomes， and patient satisfaction[J]. Plast Reconstr Surg， 2006， 118(4)：832-839.
12. Spear SL， Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast：recent trends and therapeuticimplications[J]. Plast Reconstr Surg， 2000， 105(3)：930-942.
13. Ascherman JA， Hanasono MM， Newman MI， et al. Implant reconstruction in breast cancer patients treated with radiation therapy[J]. Plast Reconstr Surg， 2006， 117(2)：359-365.
14. Baschnagel AM， Shah C， Wilkinson JB， et al. Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation[J]. Clin Breast Cancer， 2012， 12(6)：428-432.
15. Ho A， Cordeiro P， Disa J， et al. Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation[J]. Cancer， 2012， 118(9)：2552-2559.
16. Tallet AV， Salem N， Moutardier V， et al. Radiotherapy and imme-diate two-stage breast reconstruction with a tissue expander and implant：complications and esthetic results[J]. Int J Radiat OncolBiol Phys， 2003， 57(1)：136-142.
17. Benediktsson K， Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients：five years of monitoring of a prospective trial[J]. J Plast Reconstr Aesthet Surg， 2006， 59(1)：27-34.
18. Kronowitz SJ. Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2012， 130(4)：513e-524e.
19. Spear SL， Mardini S， Ganz JC. Resource cost comparison ofimplant-based breast reconstruction versus TRAM flap breast recons-truction[J]. Plast Reconstr Surg， 2003， 112(1)：101-105.
20. Blondeel N， Vanderstraeten GG， Monstrey SJ， et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction[J]. Br J Plast Surg， 1997， 50(5)：322-330.
21. Williams JK， Carlson GW， Bostwick J 3rd， et al. The effects of radiation treatment after TRAM flap breast reconstruction[J]. Plast Reconstr Surg， 1997， 100(5)：1153-1160.
22. Tran NV， Chang DW， Gupta A， et al. Comparison of immediateand delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy[J]. Plast Reconstr Surg， 2001， 108(1)：78-82.
23. Rogers NE， Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap[J]. Plast ReconstrSurg， 2002， 109(6)：1919-1924.
24. Shah C， Kundu N， Arthur D， et al. Radiation therapy following postmastectomy reconstruction：a systematic review[J]. Ann Surg Oncol， 2013， 20(4)：1313-1322.
25. Durkan B， Amersi F， Phillips EH， et al. Postmastectomy radiation of latissimus dorsi myocutaneous flap reconstruction is well tolerated in women with breast cancer[J]. Am Surg， 2012， 78(10)：1122-1127.
26. Barry M， Kell MR. Radiotherapy and breast reconstruction：a meta-analysis[J]. Breast Cancer Res Treat， 2011， 127(1)：15-22.
27. Carlson GW， Page AL， Peters K， et al. Effects of radiation therapyon pedicled transverse rectus abdominis myocutaneous flap breast reconstruction[J]. Ann Plast Surg， 2008， 60(5)：568-572.
28. Spear SL， Ducic I， Low M， et al. The effect of radiation on pedicled TRAM flap breast reconstruction：outcomes and implications[J]. Plast Reconstr Surg， 2005， 115(1)：84-95.
29. Makmur L， Lim J， Lim TC. Radiation therapy in immediate breast reconstruction with DIEP flap[J]. Plast Reconstr Surg， 2003， 112(3)：920-921.
30. Momoh AO， Colakoglu S， de Blacam C， et al. Delayed autologous breast reconstruction after postmastectomy radiation therapy：is there an optimal time?[J]. Ann Plast Surg， 2012， 69(1)：14-18.
31. Evans GR， Schusterman MA， Kroll SS， et al. Reconstruction and the radiated breast：is there a role for implants?[J]. Plast Reconstr Surg， 1995， 96(5)：1111-1115.
32. Christante D， Pommier SJ， Diggs BS， et al. Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making[J]. Arch Surg， 2010， 145(9)：873-878.
33. Kronowitz SJ， Chang DW， Robb GL， et al. Implications of axillarysentinel lymph node biopsy in immediate autologous breast reconstruction[J]. Plast Reconstr Surg， 2002， 109(6)：1888-1896.
34. Kronowitz SJ， Hunt KK， Kuerer HM， et al. Delayed-immediate breast reconstruction[J]. Plast Reconstr Surg， 2004， 113(6)：1617-1628.
35. Kronowitz SJ. Delayed-immediate breast reconstruction：technicaland timing considerations[J]. Plast Reconstr Surg， 2010， 125(2)：463-474.
36. Kronowitz SJ， Kuerer HM. Advances and surgical decision-making for breast reconstruction[J]. Cancer， 2006， 107(5)：893-907.
37. Motwani SB， Strom EA， Schechter NR， et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy[J]. Int J Radiat Oncol Biol Phys， 2006， 66(1)：76-82.
38. Chung E， Marsh RB， Griffith KA， et al. Quantifying dose to the reconstructed breast：can we adequately treat?[J]. Med Dosim， 2013， 38(1)：55-59.
39. Ohri N， Cordeiro PG， Keam J， et al. Quantifying the impact of immediate reconstruction in postmastectomy radiation：a large， dose-volume histogram-based analysis[J]. Int J Radiat Oncol Biol Phys， 2012， 84(2)：e153-e159.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Current Status of Postmastectomy Radiation and Breast Reconstruction

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