Evaluating the outcomes and safety of radiotherapy after immediate breast reconstruction following breast-conserving surgery

This study compared the effectiveness and safety outcomes of radiotherapy (RT) after immediate autologous breast reconstruction (IABR) following breast-conserving surgery (BCS) in patients with breast cancer. The data showed that RT following IABR provided aesthetically satisfactory results with manageable side effects in these patients.

BC is one of the most common cancers found in women globally. The treatment options for breast cancer (BC) usually include surgery. This can involve the total removal of the breast (mastectomy) or breast-conserving surgery (BCS). BCS involves the removal of the tumor only, with the preservation of the breast. Radiation therapy (RT) is also commonly used following surgery to destroy any remaining cancer cells and reduce the risk of recurrence.

Breast reconstruction (BR) is a key part of BC treatment in women who need a mastectomy. Immediate autologous breast reconstruction (IABR) after mastectomy has been increasingly in demand in BC patients. It allows the transfer of the patient’s own tissue (skin, fat, muscle) from another place on the patient’s body to form a breast shape with minimal scarring. The tissue (called a "flap") usually comes from the belly, the back, buttocks, or inner thighs to create the reconstructed breast. Previous studies have shown that patients who received IABR were more satisfied with their breasts and reached higher levels of mental and sexual health than those who received implant-based reconstruction.

RT may damage the transplanted tissue and may slow down healing. However, the outcomes of RT after IABR following BCS are still unknown.

This study involved 84 patients with BC. These patients previously underwent BCS and IABR and were recommended RT. Patients were divided into 2 groups. Group 1 included 32 patients who received RT at an average of 4.1 months after IABR. Group 2 included 52 patients who did not receive RT. The average follow-up time was 33.3 months.

A similar number of patients in the RT group (3.13%) experienced regional recurrence and the non-RT group (3.85%). After 2 years, 96.9% of group 1 and 98.1% of group 2 were alive and disease-free.

Overall good cosmetic outcomes (the physical aspect of the breast after treatment including skin retraction, size, and shape of the breast) were achieved in 91.7% of patients before RT, 83.3% of patients after 1 month of RT, and 98.8% of patients after 6 months of RT. Differences in skin color were seen between groups after 1 month. However, after 6 months there were no differences in cosmetic outcomes between groups. 

No significant difference in the reduction of flap size was found between the two groups. There were also no significant differences between the two groups in the rates of complications after surgery.

This study concluded that RT after IABR resulted in good esthetic outcomes and did not increase complications after surgery. The authors suggested that additional RT can be safely given to patients who underwent IABR after partial mastectomy.

This study looked back in time at medical records and included a small group of patients. The follow-up period was rather short to fully evaluate the long-term complications of RT.