Augmenting the timeline of breast reconstruction.

The current standard at most academic centers in the U.S. is delayed reconstruction for women who may require post-mastectomy radiation (PMRT). This is largely due to concerns over increased toxicity with immediate reconstruction, despite its apparent psychological benefits. Regrettably, most (all?) of our data is observational at best: Most recently, a group from Spain published outcomes on 190 immediate abdominal free flap reconstructions with almost half receiving PMRT. They report no differences in fat necrosis or quality of life and satisfaction scores with PMRT at a median of 2 years. Why do we care? With the positive results of the MA.20 trial in 2015, the pendulum is swinging back towards a lower threshold for PMRT...which means we are all going to be seeing more of these patients. Unfortunately, this newer data does little more than fan the flames of the immediate versus delayed reconstruction debate. So, for now, the best oncologists can do is ensure our breast patients are seen upfront by plastic surgeons, ones who are aware of the patient’s potential receipt of PMRT and willing to have informative discussions on timing options for reconstruction.