Expanding our understanding.

Top Line: When it comes to the best time to irradiate in the breast reconstruction sequence, what clear guidance can we find in the NCCN guidelines we all hold near and dear? 

The Study: “The preferred approach to breast reconstruction for irradiated patients was a subject of controversy among the panel.” Sigh. Most folks can agree on two things. First, staging an autologous tissue transfer after radiation completion is probably best. Second, tissue expansion prior to a staged implant exchange reduces the risk of capsular contracture. This retrospective look at 661 women undergoing a two-stage expander/implant reconstruction aimed to further elucidate things. Two things stood out among the 309 women receiving post-mastectomy radiation. Sequencing the radiation after final expansion but before implant exchange resulted in a higher rate of complications (40%) than when radiation was done after the implant exchange (32%). Another hypothesis-generating observation was a sky-high rate of capsular contracture (47%) among the 17 patients receiving proton PMRT as compared to 10-16% among the remaining 292 women receiving photon PMRT with and without a boost.

TBL: For the many women who undergo a two-stage implant reconstruction, it may be safest to deliver post-mastectomy radiation after the implant is in place. | Naoum, Pract Radiat Oncol 2022