Skip to main content

Advertisement

SpringerLink
Log in

Radiotherapy and breast reconstruction: a meta-analysis

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The optimum sequencing of breast reconstruction (BR) in patients receiving postmastectomy radiation therapy (PMRT) is controversial. A comprehensive search of published studies that examined postoperative morbidity following immediate or delayed BR with combined radiotherapy was performed. Medical (MEDLINE & EMBASE) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured. A total of 1,105 patients were identified from 11 appropriately selected studies. Patients undergoing PMRT and BR are more likely to suffer morbidity compared with patients not receiving PMRT (OR = 4.2; 95% CI, 2.4–7.2 [no PMRT vs. PMRT]). Reconstruction technique was also examined with outcome when PMRT was delivered after BR, and this demonstrated that autologous reconstruction is associated with less morbidity in this setting (OR = 0.21; 95% CI, 0.1–0.4 [autologous vs. implant-based]). Delaying BR until after PMRT had no significant effect on outcome (OR = 0.87; 95% CI, 0.47–1.62 [delayed vs. immediate]). PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared with implant-based reconstruction.

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.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Eng J Med 347:1233–1241

    Article  Google Scholar 

  2. Chevray PM (2008) Timing of breast reconstruction: immediate versus delayed. Cancer J 14(4):223–229

    Article  PubMed  Google Scholar 

  3. Meretoja TJ, von Smitten KA, Leidenius MH, Svarvar C, Heikkila PS, Jahkola TA (2007) Local recurrence of stage 1 and 2 breast cancer after skin sparing mastectomy and immediate breast reconstruction in a 15 year series. Eur J Surg Oncol 33:1142–1145

    PubMed  CAS  Google Scholar 

  4. Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337:949–955

    Article  PubMed  CAS  Google Scholar 

  5. Ragaz K, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node positive premenopausal women with breast cancer. N Engl J Med 337:956–962

    Article  PubMed  CAS  Google Scholar 

  6. Recht A, Edge SB, Solin LJ et al (2001) Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1539–1569

    PubMed  CAS  Google Scholar 

  7. Harris JR, Halpin-Murphy P, McNeese M et al (1999) Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 44:989–990

    Article  PubMed  CAS  Google Scholar 

  8. Rutqvist LE, Rose C, Cavallin-Ståhl E (2003) A systematic overview of radiation therapy effects in breast cancer. Acta Oncol 42(5–6):532–545

    Article  PubMed  Google Scholar 

  9. Truong PT, Woodward WA, Bucholz TA (2006) Optimizing locoregional control and survival for women with breast cancer: a review of current developments in postmastectomy radiation. Expert Rev Anticancer Ther 6:205–216

    Article  PubMed  Google Scholar 

  10. Wong JS, Ho AY, Kaelin CM, Bishop KL, Silver B, Gelman R, Harris JR, Hergrueter CA (2008) Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy. Breast J 14(1):49–54

    Article  PubMed  Google Scholar 

  11. Anderson PR, Hanlon AL, Fowble BL, McNeeley SW, Freedman GM (2004) Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy. Int J Radiat Oncol Biol Phys 59(4):1080–1087

    Article  PubMed  Google Scholar 

  12. Thomson HJ, Potter S, Greenwood RJ, Bahl A, Barker J, Cawthorn SJ, Winters ZE (2008) A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 15(4):1081–1091 Epub 26 Jan 2008

    Article  PubMed  Google Scholar 

  13. Miller MJ, Rock CS, Robb GL (1996) Aesthetic breast reconstruction using a combination of free transverse rectus abdominis musculocutaneous flaps and breast implants. Ann Plast Surg 37(3):258–264

    Article  PubMed  CAS  Google Scholar 

  14. Kroll SS, Marchi M (1991) Immediate reconstruction: current status in cancer management. Tex Med 87:67–72

    PubMed  CAS  Google Scholar 

  15. Spear SL, Ducic I, Low M, Cuoco F (2005) The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg 115(1):84–95

    PubMed  CAS  Google Scholar 

  16. Dean C, Chetty U, Forrest AP (1983) Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1:459–462

    Article  PubMed  CAS  Google Scholar 

  17. Bloomer WD, Hellman S (1975) Normal issue responses to radiation therapy. N Engl J Med 293:80–83

    Article  PubMed  CAS  Google Scholar 

  18. Fajardo LF, Berthrong M (1978) Radiation injury in surgical pathology: part I. Am J Surg Pathol 2:159–199

    Article  PubMed  CAS  Google Scholar 

  19. Fajardo LF (1989) Morphologic patterns of radiation injury. Front Radiat Ther Oncol 23:75–84

    PubMed  CAS  Google Scholar 

  20. Kronowitz SJ, Robb GL (2004) Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 114(4):950–960

    Article  PubMed  Google Scholar 

  21. Buchholz TA, Kronowitz SJ, Kuerer HM (2002) Immediate breast reconstruction after skin-sparing mastectomy for treatment of advanced breast cancer: radiation oncology considerations. Ann Surg Oncol 9:820–821

    Article  PubMed  Google Scholar 

  22. Strålman K, Mollerup CL, Kristoffersen US, Elberg JJ (2008) Long-term outcome after mastectomy with immediate breast reconstruction. Acta Oncol 47(4):704–708

    Article  PubMed  Google Scholar 

  23. Huang CJ, Hou MF, Lin SD et al (2006) Comparison of local recurrence and distant metastases between breast cancer patients after postmastectomy radiotherapy with and without immediate TRAM flap reconstruction. Plast Reconstr Surg 118(5):1079–1086

    Article  PubMed  CAS  Google Scholar 

  24. Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826

    PubMed  CAS  Google Scholar 

  25. Tallet AV, Salem N, Moutardier V et al (2003) Radiotherapy and immediate two stage breast reconstruction with a tissue expander and implant: complications and aesthetic results. Int J Radiat Oncol Biol Phys 57(1):136–142

    Article  PubMed  Google Scholar 

  26. Krueger EA, Wilkins EG, Strawderman M et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49(3):713–721

    Article  PubMed  CAS  Google Scholar 

  27. Cordeiro PG, Pusic AL, Disa JJ et al (2004) Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 113(3):877–881

    Article  PubMed  Google Scholar 

  28. Whitfield GA, Horan G, Irwin MS et al (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions. Radiother Oncol 90:141–147

    Article  PubMed  Google Scholar 

  29. Jhaveri JD, Rush SC, Kostroff K, Derisi D, Farber LA, Maurer VE, Bosworth JL (2008) Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction. Int J Radiat Oncol Biol Phys 72(3):859–865

    Article  PubMed  Google Scholar 

  30. Williams JK, Carlson GW, Bostwick J 3rd, Bried JT, Trimble J, Mackay G (1997) The effects of radiation treatment after TRAM flap breast reconstruction. Plast Reconstr Surg 100(5):1153–1160

    Article  PubMed  CAS  Google Scholar 

  31. Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL (2001) Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 108(1):78–82

    Article  PubMed  CAS  Google Scholar 

  32. Ascherman JA, Hanasono MM, Newman MI, Hughes DB (2006) Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg 117(2):359–365

    Article  PubMed  CAS  Google Scholar 

  33. Motwani SB, Strom EA, Schechter NR, Butler CE, Lee GK, Langstein HN, Kronowitz SJ, Meric-Bernstam F, Ibrahim NK, Buchholz TA (2006) The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys 66(1):76–82

    Article  PubMed  Google Scholar 

  34. Kronowitz SJ, Hunt KK, Kuerer HM, Babiera G, McNeese MD, Buchholz TA, Strom EA, Robb GL (2004) Delayed-immediate breast reconstruction. Plast Reconstr Surg 113(6):1617–1628

    Article  PubMed  Google Scholar 

  35. McKeown DJ, Hogg FJ, Brown IM, Walker MJ, Scott JR, Weiler-Mithoff EM (2009) The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome. J Plast Reconstr Aesthet Surg 62(4):488–493 Epub 11 Feb 2008

    Article  PubMed  CAS  Google Scholar 

  36. Kroll SS, Robb GL, Reece GP, Miller MJ, Evans GR, Baldwin BJ, Wang B, Schusterman MA (1998) Does prior irradiation increase the risk of total or partial free-flap loss? J Reconstr Microsurg 14(4):263–268

    Article  PubMed  CAS  Google Scholar 

  37. Chang DW, Wang B, Robb GL et al (2000) Effect of obesity on flap and donor site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg 105:1640–1648

    Article  PubMed  CAS  Google Scholar 

  38. Chang DW, Reece GP, Wang B (2000) Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg 105:2374–2380

    Article  PubMed  CAS  Google Scholar 

  39. Saulis AS, Mustoe TA, Fine NA (2007) A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures. Plast Reconstr Surg 119:1669–1678

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Breast Surgery, BreastCheck, Mater Misericordiae University Hospital, Dublin, Ireland

    M Barry & M. R. Kell

Authors
  1. M Barry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. R. Kell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. R. Kell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barry, M., Kell, M.R. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat 127, 15–22 (2011). https://doi.org/10.1007/s10549-011-1401-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1401-x

Keywords

Search

Navigation