Vol 70, No 1 (2020)
Review paper
Published online: 2020-03-03

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Adjuvant radiation therapy after immediate implant-based breast reconstruction

Joanna Socha12
Nowotwory. Journal of Oncology 2020;70(1):20-25.


The role of radiotherapy in the postmastectomy setting with substantial lymph node burden or locally advanced disease has been well described. In the last decade, the indications for postmastectomy radiotherapy (PMRT) have expanded in light of a measurable disease-free survival benefit, even in T1–2N1-patient subgroup. Concurrently, immediate breast reconstruction (IBR) rates after mastectomy are rapidly increasing. Optimal integration of IBR and PMRT is challenging, as PMRT has a known deleterious effect on reconstruction outcomes and IBR has been reported to pose challenges to PMRT delivery. Implant-based reconstruction is the most common type of IBR performed nowadays. This article reviews the current problems regarding integration of the implant-based IBR with optimum radiation delivery and discusses the advantages and disadvantages of each reconstruction method with PMRT.

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  1. McGale P, Taylor C, Correa C, et al. EBCTCG (Early Breast Cancer Trialists' Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383(9935): 2127–2135.
  2. Marks LB, Kaidar-Person O, Poortmans P. Regarding Current Recommendations for Postmastectomy Radiation Therapy in Patients With One to Three Positive Axillary Lymph Nodes. J Clin Oncol. 2017; 35(11): 1256–1258.
  3. Frasier LL, Holden S, Holden T, et al. Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines. JAMA Oncol. 2016; 2(1): 95–101.
  4. Momoh AO, Ahmed R, Kelley BP, et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol. 2014; 21(1): 118–124.
  5. Kelley BP, Ahmed R, Kidwell KM, et al. A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal? Ann Surg Oncol. 2014; 21(5): 1732–1738.
  6. Jagsi R, Jiang J, Momoh AO, et al. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis. Ann Surg. 2016; 263(2): 219–227.
  7. Chen SA, Hiley C, Nickleach D, et al. Breast reconstruction and post-mastectomy radiation practice. Radiat Oncol. 2013; 8: 45.
  8. Kuerer HM, Cordeiro PG, Mutter RW. Optimizing Breast Cancer Adjuvant Radiation and Integration of Breast and Reconstructive Surgery. Am Soc Clin Oncol Educ Book. 2017; 37: 93–105.
  9. National Comprehensive Cancer Network, Breast Cancer, Version 1.2020. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (24.01.2020).
  10. Aristei C, Kaidar-Person O, Tagliaferri L, et al. The Assisi Think Tank Meeting and Survey of post MAstectomy Radiation Therapy after breast reconstruction: The ATTM-SMART report. Eur J Surg Oncol. 2018; 44(4): 436–443.
  11. Brennan ME, Flitcroft K, Warrier S, et al. Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer. Breast. 2016; 30: 59–65.
  12. Gieni M, Avram R, Dickson L, et al. Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast. 2012; 21(3): 230–236.
  13. Zhang P, Li CZ, Wu CT, et al. Comparison of immediate breast reconstruction after mastectomy and mastectomy alone for breast cancer: A meta-analysis. Eur J Surg Oncol. 2017; 43(2): 285–293.
  14. Bjöhle J, Onjukka E, Rintelä N, et al. Post-mastectomy radiation therapy with or without implant-based reconstruction is safe in terms of clinical target volume coverage and survival - A matched cohort study. Radiother Oncol. 2019; 131: 229–236.
  15. Wu SG, Zhang WW, Sun JY, et al. Comparison of survival outcomes of locally advanced breast cancer patients receiving post-mastectomy radiotherapy with and without immediate breast reconstruction: a population-based analysis. Cancer Manag Res. 2018; 10: 1993–2002.
  16. Haviland JS, Bentzen SM, Bliss JM, et al. START Trial Management Group. Prolongation of overall treatment time as a cause of treatment failure in early breast cancer: An analysis of the UK START (Standardisation of Breast Radiotherapy) trials of radiotherapy fractionation. Radiother Oncol. 2016; 121(3): 420–423.
  17. Chen TA, Momeni A, Lee GK. Clinical outcomes in breast cancer expander-implant reconstructive patients with radiation therapy. J Plast Reconstr Aesthet Surg. 2016; 69(1): 14–22.
  18. Lam TC, Hsieh F, Boyages J. The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review. Plast Reconstr Surg. 2013; 132(3): 511–518.
  19. Whitfield GA, Horan G, Irwin MS, et al. Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions. Radiother Oncol. 2009; 90(1): 141–147.
  20. Lam TC, Borotkanics R, Hsieh F, et al. Immediate Two-Stage Prosthetic Breast Reconstruction Failure: Radiation Is Not the Only Culprit. Plast Reconstr Surg. 2018; 141(6): 1315–1324.
  21. Cordeiro PG, Albornoz CR, McCormick B, et al. What Is the Optimum Timing of Postmastectomy Radiotherapy in Two-Stage Prosthetic Reconstruction: Radiation to the Tissue Expander or Permanent Implant? Plast Reconstr Surg. 2015; 135(6): 1509–1517.
  22. Sbitany H, Gomez-Sanchez C, Piper M, et al. Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits. Plast Reconstr Surg. 2019; 143(1): 10–20.
  23. Sinnott CJ, Persing SM, Pronovost M, et al. Impact of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction. Ann Surg Oncol. 2018; 25(10): 2899–2908.
  24. Salibian AH, Harness JK, Mowlds DS. Staged Suprapectoral Expander/Implant Reconstruction without Acellular Dermal Matrix following Nipple-Sparing Mastectomy. Plast Reconstr Surg. 2017; 139(1): 30–39.
  25. Vargo JA, Beriwal S. In reply to Chang et al.: Contouring guidelines for post-mastectomy radiotherapy a cry for international consensus. Radiother Oncol. 2017; 123(3): 483–484.
  26. Kaidar-Person O, Vrou Offersen B, Hol S, et al. ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer. Radiother Oncol. 2019; 137: 159–166.
  27. Kuske RR, Schuster R, Klein E, et al. Radiotherapy and breast reconstruction: clinical results and dosimetry. Int J Radiat Oncol Biol Phys. 1991; 21(2): 339–346.
  28. Thomas K, Rahimi A, Spangler A, et al. Radiation practice patterns among United States radiation oncologists for postmastectomy breast reconstruction and oncoplastic breast reduction. Pract Radiat Oncol. 2014; 4(6): 466–471.
  29. Gee HE, Bignell F, Odgers D, et al. In vivo dosimetric impact of breast tissue expanders on post-mastectomy radiotherapy. J Med Imaging Radiat Oncol. 2016; 60(1): 138–145.
  30. Thompson RCA, Morgan AM. Investigation into dosimetric effect of a MAGNA-SITE tissue expander on post-mastectomy radiotherapy. Med Phys. 2005; 32(6): 1640–1646.
  31. Chatzigiannis C, Lymperopoulou G, Sandilos P, et al. Dose perturbation in the radiotherapy of breast cancer patients implanted with the Magna-Site: a Monte Carlo study. J Appl Clin Med Phys. 2011; 12(2): 3295.

Nowotwory. Journal of Oncology