Certain breast reconstruction impacts radiation therapy outcomes

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For mastectomy patients who undergo radiation therapy after immediate breast reconstruction, autologous tissue reconstruction provides fewer long-term complications and better cosmetic results than tissue expander and implant reconstruction, according to a study in the November issue of the International Journal of Radiation Oncology*Biology*Physics.

With radiation therapy increasingly becoming the standard of care for high-risk breast cancer patients after mastectomy, the authors wrote that this can cause a problem for both patients and their radiation oncologists.

The researchers at the department of radiation oncology at Long Island Radiation Therapy in Garden City, N.Y., along with colleagues from other departments of surgery throughout New York, sought to determine if the type of reconstruction performed on women undergoing radiation after a mastectomy, had an impact on their long-term outcomes.

The investigators said that two types of reconstruction are available for patients undergoing mastectomy for breast cancer: autologous tissue reconstruction (ATR), which involves the placement of a tissue flap as a breast mound, and tissue expander and implant reconstruction (TE/I), which involves placing an inflatable tissue expander over the chest wall and exchanging it for a permanent implant at a later date.

The study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and post-mastectomy radiation therapy, according to the authors.

The researchers observed 92 patients for 38 months following their reconstruction and radiation treatments, and found that ATR is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than TE/I.

None of the 23 ATR patients required surgical intervention, while 33 percent of TE/I patients needed surgery to correct a problem with their reconstruction. According to the authors, 83 percent of ATR patients reported acceptable cosmetic outcome, as opposed to only 54 percent of TE/I patients.

"This study is useful for patients who are candidates for either ATR or TE/I and are making a decision with regards to reconstruction technique," said the study’s lead author Jigna Jhaveri, MD, a radiation oncologist at Advanced Radiation Centers in Hauppauge, N.Y. “Our study provides evidence that patients who undergo ATR and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo TE/I reconstruction and radiation therapy.”