Babak J. Mehrara, MD
Chier, Plastic and Reconstructive
Peter G. Cordeiro Endowed Chair in Plastic and Reconstructive Surgery
Memorial Sloan Kettering Cancer Center
New York, New York
Radiation can have major deleterious effects on the cosmetic outcomes of reconstructive procedures.1
As a result, the timing of reconstruction in women who may require postmastectomy radiotherapy (PMRT) is a heavily debated topic. Now, emerging evidence shows that immediate autologous breast reconstruction can tolerate radiotherapy better than previously thought in select cases.
Temporary Implants in Women Who May Need Radiation
In some women, it is unclear whether they will require PMRT until their mastectomy and lymph node sampling are performed. This is a reconstructive dilemma, because it is difficult to provide adequate counseling regarding the potential effects of PMRT on cosmetic outcomes. In some cases, using temporary implants (tissue expanders) is helpful because it enables the plastic surgeon to preserve the breast skin and contours after mastectomy while awaiting the decision for PMRT following review of the pathology results. This approach preserves the woman’s choice to undergo implant or autologous reconstruction and facilitates delivery of PMRT.
Autologous Reconstruction and PMRT Timing
Historically, most surgeons have not recommended autologous tissue reconstruction in patients who will require PMRT. This position stems from a 2001 study that found higher rates of fat necrosis and volume in women who underwent immediate reconstruction with autologous tissues followed by subsequent treatment with PMRT.5
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