Skip to main content

Advertisement

SpringerLink
Log in

Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology

  • Special Feature
  • Current controversies in postmastectomy radiation therapy in breast cancer
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Breast reconstruction (BR) represents a suitable option for women who are not expected to require postmastectomy radiotherapy (PMRT). As recent evidence has led to an extension of the indications for PMRT, this has also appeared to increase the incidence of reconstructive complications. Nevertheless, in the USA at least, trends towards BR are changing. The frequency of immediate reconstruction continues to increase, even in the setting of PMRT. In immediate implant-based reconstruction, a staged approach is preferred. The failure rate of PMRT in implant patients is lower than that with expander patients. In delayed implant-based construction, tissue expansion of irradiated skin leads to a significantly increased risk of complications. In contrast, autologous tissue appears to tolerate radiation damage better than implant-based reconstructions. No significant differences have been described when complication rates of immediate autologous tissue BR with PMRT were compared with delayed autologous tissue BR following PMRT. In previously radiated patients, autologous tissue BR is preferred, and it may be safer when carried out ≥ 12 months after PMRT. Several other problems are associated with radiation delivery after BR and the clues to solve them are reviewed in this paper.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Katanoda K, Hori M, Matsuda T, Shibata A, Nishino Y, Hattori M, et al. An updated report on the trends in cancer incidence and mortality in Japan, 1958–2013. Jpn J Clin Oncol. 2015;45:390–401.

    Article  PubMed  Google Scholar 

  2. Kurebayashi J, Miyoshi Y, Ishikawa T, Saji S, Sugie T, Suzuki T, et al. Clinicopathological characteristics of breast cancer and trends in the management of breast cancer patients in Japan: based on the Breast Cancer Registry of the Japanese Breast Cancer Society between 2004 and 2011. Breast Cancer. 2015;22:235–44.

    Article  PubMed  Google Scholar 

  3. National Borstkanker Overleg Nederland. Breast cancer Dutch Guideline, version 2.0. Breast cancer Dutch Guideline, version 20; 2012. http://www.oncoline.nl/uploaded/docs/mammacarcinoom/Dutch%20Breast%20Cancer%20Guideline%202012.pdf.

  4. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983;1:459–62.

    Article  CAS  PubMed  Google Scholar 

  5. Gieni M, Avram R, Dickson L, Farrokhyar F, Lovrics P, Faidi S, et al. Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast. 2012;21:230–6.

    Article  CAS  PubMed  Google Scholar 

  6. Barry M, Kell MR. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat. 2011;127:15–22.

    Article  CAS  PubMed  Google Scholar 

  7. EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. 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;383:2127–35.

    Article  Google Scholar 

  8. NCCN. Clinical practice guidelines in oncology: breast cancer. version 2, 2016. Clinical practice guidelines in oncology: breast cancer version 2, 2016; 2016. http://www.nccn.org/.

  9. Jinno H, Inokuchi M, Ito T, Kitamura K, Kutomi G, Sakai T, et al. The Japanese Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer, 2015 edition. Breast Cancer. 2016;23:367–77.

    Article  PubMed  Google Scholar 

  10. Jagsi R, Jiang J, Momoh AO, Alderman A, Giordano SH, Buchholz TA, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32:919–26.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Agarwal S, Kidwell KM, Farberg A, Kozlow JH, Chung KC, Momoh AO. Immediate reconstruction of the radiated breast: recent trends contrary to traditional standards. Ann Surg Oncol. 2015;22:2551–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Frasier LL, Holden S, Holden T, Schumacher JR, Leverson G, Anderson B, et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in national comprehensive cancer network guidelines. JAMA Oncol. 2016;2:95–101.

    Article  PubMed  PubMed Central  Google Scholar 

  13. El-Sabawi B, Sosin M, Carey JN, Nahabedian MY, Patel KM. Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol. 2015;112:458–64.

    Article  PubMed  Google Scholar 

  14. Wilkins EG, Hamill JB, Kim HM, Kim JY, Greco RJ, Qi J, et al. Complications in postmastectomy breast reconstruction: One-year outcomes of the mastectomy reconstruction outcomes consortium (MROC) study. Ann Surg. 2016 (in press).

  15. Tsoi B, Ziolkowski NI, Thoma A, Campbell K, O’Reilly D, Goeree R. Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients: a systematic review and meta-analysis. Plast Reconstr Surg. 2014;133:234–49.

    Article  CAS  PubMed  Google Scholar 

  16. Shah C, Kundu N, Arthur D, Vicini F. Radiation therapy following postmastectomy reconstruction: a systematic review. Ann Surg Oncol. 2013;20:1313–22.

    Article  PubMed  Google Scholar 

  17. 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;132:511–8.

    Article  CAS  PubMed  Google Scholar 

  18. Berbers J, van Baardwijk A, Houben R, Heuts E, Smidt M, Keymeulen K, et al. ‘Reconstruction: before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer. 2014;50:2752–62.

    Article  PubMed  Google Scholar 

  19. Santosa KB, Chen X, Qi J, Ballard TN, Kim HM, Hamill JB, et al. Postmastectomy radiation therapy and two-stage implant-based breast reconstruction: is there a better time to irradiate? Plast Reconstr Surg. 2016;138:761–9.

    Article  CAS  PubMed  Google Scholar 

  20. Peled AW, Foster RD, Esserman LJ, Park CC, Hwang ES, Fowble B. Increasing the time to expander-implant exchange after postmastectomy radiation therapy reduces expander-implant failure. Plast Reconstr Surg. 2012;130:503–9.

    Article  CAS  PubMed  Google Scholar 

  21. Lee KT, Mun GH. Prosthetic breast reconstruction in previously irradiated breasts: a meta-analysis. J Surg Oncol. 2015;112:468–75.

    Article  PubMed  Google Scholar 

  22. Yamauchi C, Sekiguchi K, Nishioka A, Arahira S, Yoshimura M, Ogo E, et al. The Japanese Breast Cancer Society Clinical Practice Guideline for radiation treatment of breast cancer, 2015 edition. Breast Cancer. 2016;23:378–90.

    Article  PubMed  Google Scholar 

  23. Berry T, Brooks S, Sydow N, Djohan R, Nutter B, Lyons J, et al. Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Oncol. 2010;17(Suppl 3):202–10.

    Article  PubMed  Google Scholar 

  24. Fracol ME, Basta MN, Nelson JA, Fischer JP, Wu LC, Serletti JM, et al. Bilateral free flap breast reconstruction after unilateral radiation: comparing intraoperative vascular complications and postoperative outcomes in radiated versus nonradiated breasts. Ann Plast Surg. 2016;76:311–4.

    Article  CAS  PubMed  Google Scholar 

  25. Schaverien MV, Macmillan RD, McCulley SJ. Is immediate autologous breast reconstruction with postoperative radiotherapy good practice?: a systematic review of the literature. J Plast Reconstr Aesthet Surg. 2013;66:1637–51.

    Article  PubMed  Google Scholar 

  26. Rochlin DH, Jeong AR, Goldberg L, Harris T, Mohan K, Seal S, et al. Postmastectomy radiation therapy and immediate autologous breast reconstruction: integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery. J Surg Oncol. 2015;111:251–7.

    Article  PubMed  Google Scholar 

  27. Momoh AO, Colakoglu S, de Blacam C, Gautam S, Tobias AM, Lee BT. Delayed autologous breast reconstruction after postmastectomy radiation therapy: is there an optimal time? Ann Plast Surg. 2012;69:14–8.

    Article  CAS  PubMed  Google Scholar 

  28. Fosnot J, Fischer JP, Smartt JM Jr, Low DW, Kovach SJ 3rd, Wu LC, et al. Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction? Plast Reconstr Surg. 2011;127:496–504.

    Article  CAS  PubMed  Google Scholar 

  29. Baumann DP, Crosby MA, Selber JC, Garvey PB, Sacks JM, Adelman DM, et al. Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy. Plast Reconstr Surg. 2011;127:1100–6.

    Article  CAS  PubMed  Google Scholar 

  30. Cordeiro PG, Albornoz CR, McCormick B, Hu Q, Van Zee K. The impact of postmastectomy radiotherapy on two-stage implant breast reconstruction: an analysis of long-term surgical outcomes, aesthetic results, and satisfaction over 13 years. Plast Reconstr Surg. 2014;134:588–95.

    Article  CAS  PubMed  Google Scholar 

  31. Hickey BE, Francis DP, Lehman M. Sequencing of chemotherapy and radiotherapy for early breast cancer. Cochrane Database Syst Rev. 2013;4:CD005212.

    Google Scholar 

  32. Olivotto IA, Lesperance ML, Truong PT, Nichol A, Berrang T, Tyldesley S, et al. Intervals longer than 20 weeks from breast-conserving surgery to radiation therapy are associated with inferior outcome for women with early-stage breast cancer who are not receiving chemotherapy. J Clin Oncol. 2009;27:16–23.

    Article  PubMed  Google Scholar 

  33. Tsoutsou PG, Koukourakis MI, Azria D, Belkacemi Y. Optimal timing for adjuvant radiation therapy in breast cancer: a comprehensive review and perspectives. Crit Rev Oncol Hematol. 2009;71:102–16.

    Article  PubMed  Google Scholar 

  34. Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003;21:555–63.

    Article  PubMed  Google Scholar 

  35. Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol. 2008;87:3–16.

    Article  PubMed  Google Scholar 

  36. Buchholz TA, Austin-Seymour MM, Moe RE, Ellis GK, Livingston RB, Pelton JG, et al. Effect of delay in radiation in the combined modality treatment of breast cancer. Int J Radiat Oncol Biol Phys. 1993;26:23–35.

    Article  CAS  PubMed  Google Scholar 

  37. Metz JM, Schultz DJ, Fox K, Mathews A, Glick J, Solin LJ. Analysis of outcomes for high-risk breast cancer based on interval from surgery to postmastectomy radiation therapy. Cancer J. 2000;6:324–30.

    CAS  PubMed  Google Scholar 

  38. The International Commission on Radiation Units and Measurement. ICRU 50: prescribing, recording, and reporting photon beam therapy. Bethesda; 1993.

  39. Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete Sola A, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol. 2015;114:3–10.

    Article  PubMed  Google Scholar 

  40. Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Sola AB, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1. Radiother Oncol. 2016;118:205–8.

    Article  PubMed  Google Scholar 

  41. White J, Tai A, Arthur D, Buchholz T, MacDonald S, Marks L, et al. Breast cancer atlas for radiation therapy planning: consensus definitions. https://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx.

  42. Massabeau C, Fournier-Bidoz N, Wakil G, Castro Pena P, Viard R, Zefkili S, et al. Implant breast reconstruction followed by radiotherapy: can helical tomotherapy become a standard irradiation treatment? Med Dosim. 2012;37:425–31.

    Article  PubMed  Google Scholar 

  43. Chatzigiannis C, Lymperopoulou G, Sandilos P, Dardoufas C, Yakoumakis E, Georgiou E, 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;12:3295.

    Article  PubMed  Google Scholar 

  44. Gee HE, Bignell F, Odgers D, Gill S, Martin D, Toohey J, et al. In vivo dosimetric impact of breast tissue expanders on post-mastectomy radiotherapy. J Med Imaging Radiat Oncol. 2016;60:138–45.

    Article  PubMed  Google Scholar 

  45. Damast S, Beal K, Ballangrud A, Losasso TJ, Cordeiro PG, Disa JJ, et al. Do metallic ports in tissue expanders affect postmastectomy radiation delivery? Int J Radiat Oncol Biol Phys. 2006;66:305–10.

    Article  PubMed  Google Scholar 

  46. Buchholz TA, Kronowitz SJ, Kuerer HM. Immediate breast reconstruction after skin-sparing mastectomy for the treatment of advanced breast cancer: radiation oncology considerations. Ann Surg Oncol. 2002;9:820–1.

    Article  PubMed  Google Scholar 

  47. Marks LB, Bentel GC, Hardenbergh PH, Lind PA, Prosnitz LR, Ollino P. A practical and easy method to locate the first three internal mammary lymph node-bearing areas [An easy and practical method for quantitative and qualitative measurement of ultraviolet radiation.]. Int J Radiat Oncol Biol Phys. 2001;50:421–5.

    Article  CAS  PubMed  Google Scholar 

  48. Motwani SB, Strom EA, Schechter NR, Butler CE, Lee GK, Langstein HN, et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:76–82.

    Article  PubMed  Google Scholar 

  49. Ohri N, Cordeiro PG, Keam J, Ballangrud A, Shi W, Zhang Z, et al. Quantifying the impact of immediate reconstruction in postmastectomy radiation: a large, dose-volume histogram-based analysis. Int J Radiat Oncol Biol Phys. 2012;84:e153–9.

    Article  PubMed  Google Scholar 

  50. Chung E, Marsh RB, Griffith KA, Moran JM, Pierce LJ. Quantifying dose to the reconstructed breast: can we adequately treat? Med Dosim. 2013;38:55–9.

    Article  PubMed  Google Scholar 

  51. Thomas K, Rahimi A, Spangler A, Anderson J, Garwood D. Radiation practice patterns among United States radiation oncologists for postmastectomy breast reconstruction and oncoplastic breast reduction. Pract Radiat Oncol. 2014;4:466–71.

    Article  PubMed  Google Scholar 

  52. Chen SA, Hiley C, Nickleach D, Petsuksiri J, Andic F, Riesterer O, et al. Breast reconstruction and post-mastectomy radiation practice. Radiat Oncol. 2013;8:45.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Matsunuma R, Oguchi M, Fujikane T, Matsuura M, Sakai T, Kimura K, et al. Influence of lymphatic invasion on locoregional recurrence following mastectomy: indication for postmastectomy radiotherapy for breast cancer patients with one to three positive nodes. Int J Radiat Oncol Biol Phys. 2012;83:845–52.

    Article  PubMed  Google Scholar 

  54. Bouganim N, Tsvetkova E, Clemons M, Amir E. Evolution of sites of recurrence after early breast cancer over the last 20 years: implications for patient care and future research. Breast Cancer Res Treat. 2013;139:603–6.

    Article  CAS  PubMed  Google Scholar 

  55. McBride A, Allen P, Woodward W, Kim M, Kuerer HM, Drinka EK, et al. Locoregional recurrence risk for patients with T1,2 breast cancer with 1-3 positive lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys. 2014;89:392–8.

    Article  PubMed  Google Scholar 

  56. Imoto S, Yamauchi C, Komoike Y, Tsugawa K, Yotsumoto D, Wada N, et al. Trends in axillary treatment for breast cancer patients undergoing sentinel lymph node biopsy as determined by a questionnaire from the Japanese Breast Cancer Society. Breast Cancer. 2016 (in press).

  57. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373:317–27.

    Article  CAS  PubMed  Google Scholar 

  58. Thorsen LB, Offersen BV, Dano H, Berg M, Jensen I, Pedersen AN, et al. DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol. 2016;34:314–20.

    Article  PubMed  Google Scholar 

  59. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Kunkler I, van Tienhoven G, Dixon M, Robin Prescott R, Russell N, Peter Canney P, et al. Postmastectomy radiotherapy should not be standard of care for women with 1–3 involved nodes. Radiother Oncol. 2007;84:103–4.

    Article  Google Scholar 

  61. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma. Cancer. 2006;106:4–16.

    Article  PubMed  Google Scholar 

  62. Wang F, Peled AW, Chin R, Fowble B, Alvarado M, Ewing C, et al. The impact of radiation therapy, lymph node dissection, and hormonal therapy on outcomes of tissue expander-implant exchange in prosthetic breast reconstruction. Plast Reconstr Surg. 2016;137:1–9.

    Article  CAS  PubMed  Google Scholar 

  63. Kronowitz SJ, Hunt KK, Kuerer HM, Babiera G, McNeese MD, Buchholz TA, et al. Delayed-immediate breast reconstruction. Plast Reconstr Surg. 2004;113:1617–28.

    Article  PubMed  Google Scholar 

  64. Wang J, Li X, Deng Q, Xia B, Wu S, Liu J, et al. Postoperative radiotherapy following mastectomy for patients with left-sided breast cancer: a comparative dosimetric study. Med Dosim. 2015;40:190–4.

    Article  PubMed  Google Scholar 

  65. Meyer E, Raupach R, Lell M, Schmidt B, Kachelriess M. Normalized metal artifact reduction (NMAR) in computed tomography. Med Phys. 2010;37:5482–93.

    Article  Google Scholar 

  66. Kassim I, Joosten H, Barnhoorn JC, Heijmen BJ, Dirkx ML. Implications of artefacts reduction in the planning CT originating from implanted fiducial markers. Med Dosim. 2011;36:119–25.

    Article  PubMed  Google Scholar 

  67. Mizuno N, Takahashi H, Kawamori J, Niibe Y, Nakamura N, Ogita M, et al. Effect of metallic ports in tissue expanders on postmastectomy radiation dose distribution. In: Proceedings of the 27th annual meeting of the Japanese Society for Radiation Oncology; 2014. p. 286 (in Japanese).

Download references

Acknowledgements

The authors gratefully acknowledge medical physicist Yukio Fujita, Ph.D. for treatment planning.

Author information

Authors and Affiliations

  1. Sonoda-kai Radiation Oncology Clinic, 3-4-19 Hokima, Adachi-ku, Tokyo, 121-0064, Japan

    Kenji Sekiguchi

  2. Department of Radiation Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Kenji Sekiguchi & Jiro Kawamori

  3. Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Hideko Yamauchi

Authors
  1. Kenji Sekiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiro Kawamori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideko Yamauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenji Sekiguchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sekiguchi, K., Kawamori, J. & Yamauchi, H. Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology. Breast Cancer 24, 511–520 (2017). https://doi.org/10.1007/s12282-017-0754-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-017-0754-3

Keywords

Search

Navigation