Radiotherapy: Principles and Consequences for Breast Reconstruction

Postmastectomy radiotherapy (PMRT) has increased in use over time. Timing and sequencing of radiation treatment in the context of breast reconstruction remain controversial. Immediate breast reconstruction (BR) has shown several psychological, economic, and social advantages but, by altering the chest wall anatomy, may complicate the PMRT delivery and increase the risk of complications and impaired cosmetic outcomes. Delayed BR can be challenging, carrying the difficulty to operate in previously irradiate fields. A modern radiotherapy approach is needed to minimize the risk of complications. In PMRT setting, the overall complication rate increases compared to non-irradiated patients, irrespective if BR is performed before or after BR. Autologous tissue appears to better handle PMRT than allogeneic BR and represents the favorite choice for patient candidate to receive PMRT or in case of previous radiotherapy. Many factors are identified as significant predictor of outcome. Despite the rate of complications and reconstruction failure, aesthetic and general satisfaction are generally high.