Breast Reconstruction at Time of Mastectomy May Affect Radiation Therapy

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EXCERPT: 52% of patients who underwent immediate reconstruction had compromises within their radiation plans compared with only 7% of the controls.

It was also more difficult to minimize radiation exposure to the lungs and avoid radiation exposure to the heart in these women.

Breast Reconstruction at Time of Mastectomy May Affect Radiation Therapy

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According to an article recently published in the International Journal of Radiation Oncology, Biology and Physics, breast reconstruction performed at the time of a mastectomy for women with breast cancer may negatively affect subsequent radiation therapy. However, the impact of these effects on patient outcomes needs further study.

A mastectomy is the complete removal of the breast for the treatment of early breast cancer. Following a mastectomy, it is often advised that patients undergo subsequent radiation therapy so that undetectable cancer cells that may remain following surgery will be killed by the radiation. This ultimately reduces a patient's risk of a cancer recurrence.

Breast reconstruction, such as inserting a breast implant, is a type of plastic surgery to restore the site of the mastectomy. Patients may choose to undergo breast reconstruction at the time of mastectomy so the two surgical procedures may be performed at the same time. Although this choice has been generally accepted, researchers are now evaluating the effects of breast reconstruction on radiation therapy.

Researchers from several institutions in the United States recently evaluated data regarding the effects of breast reconstruction at the time of mastectomy and the potential effects on subsequent radiation therapy. The data included 110 patients who underwent a mastectomy and breast reconstruction at the same time. They were compared to women who underwent a mastectomy without immediate reconstruction (controls). All patients were to receive follow-up radiation therapy.

52% of patients who underwent immediate reconstruction had compromises within their radiation plans compared with only 7% of the controls.

The ability to achieve optimal coverage of radiation therapy to the chest wall and treatment of specific lymph nodes were both reduced among women treated with immediate breast reconstruction. It was also more difficult to minimize radiation exposure to the lungs and avoid radiation exposure to the heart in these women.

Patients with cancers in their left breast who underwent immediate reconstruction had significantly more problems with radiation therapy than those with cancers in the right breast. The researchers concluded that patients who are undergoing a mastectomy and choose breast reconstruction at the time of the surgical procedure may be altering optimal plans for subsequent radiation therapy. However, further study is needed to identify patients who may be more affected than others, as well determine long-term outcomes.

Patients who are to undergo a mastectomy and who want to undergo breast reconstruction at the same time may wish to speak with their physician regarding their individual risks and benefits of immediate versus delayed breast reconstruction.

Reference: Motwani S, Strom E, Schechter N, et al. The Impact of Immediate Breast Reconstruction on the Technical Delivery of Postmastcomy Radiotherapy. International Journal of Radiation Oncology, Biology and Physics. 2006; 66: 76-82.

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