Options in reconstructing the irradiated breast.

Background: As radiation therapy becomes more prevalent in the treatment of breast cancer, more patients requesting breast reconstruction for mastectomy defects will have a history of radiation therapy.

Methods: A retrospective chart review study was performed of a single surgeon's 5-year experience with reconstruction of the irradiated breast.

Results: Sixty-six primary patients and 13 secondary patients were treated over a 5-year period (2001-2005). Of the 66 primary patients, 25 (38 percent) presented for reconstruction after recurrence following prior breast conservation therapy: 12 had prosthetic based reconstructions (with or without a latissimus flap) and 13 had autologous reconstructions. Twenty-five patients (38 percent) presented after mastectomy followed by radiation therapy: six had prosthetic-based constructions and 19 had autologous reconstructions. Twelve patients (18 percent) had their reconstructions performed before radiation therapy: nine had implant-based reconstructions and three had autologous reconstructions. Four patients (6 percent) presented for corrections of breast conservation therapy deformities. One hundred seventy-five total operations were performed for the primary patients, with an average of 2.65 operations per patient. Thirteen patients were treated secondarily after previous reconstruction at other institutions with a variety of reconstruction methods used. Twenty-eight total operations were performed for the secondary patients, with an average of 2.2 operations per patient. Capsular contracture rates using the prosthetic score are reported.

Conclusions: Because of the variability of presentation of the irradiated breast cancer patient, there is no one method of reconstruction ideally suited for all irradiated patients. In this 5-year review, the authors found that with careful patient evaluation and selection, good results can be attained regardless of reconstructive method.