Breast reconstruction plays a highly important role in the management of patients with
breast cancer, from a psycho-social and sexual stand-point. Given that immediate
breast reconstruction does not impair the oncologic safety of
breast cancer management, with no increase in local recurrence rates, and no delays in the initiation of
adjuvant chemotherapy or
radiotherapy, the need to balance cosmesis in reconstruction with the oncologic needs of
breast cancer patients is no more evident than in the discussion of
radiotherapy.
Radiotherapy is essential adjuvant
therapy in the treatment of
breast cancer, with the use of
adjuvant radiotherapy widely shown to reduce local recurrence after both partial and
total mastectomy and shown to prolong both disease-free and overall survival in patients with nodal disease. In the setting of
breast reconstruction, the effects of
radiotherapy are potentially two-fold, with consideration required of the impact of
breast reconstruction on the administration of and the initiation of
radiotherapy, as well as the effects of
radiotherapy on operative complications and cosmetic outcome following immediate
breast reconstruction. The current editorial piece aims to analyze this balance, contrasting both autologous and implant-based reconstruction. The literature is still evolving as to the relative role of autologous vs. alloplastic reconstruction in the setting of
radiotherapy, and the more recent introduction of acellular dermal matrix and other compounds further complicate the evidence. Fat grafting and evolving techniques in
breast reconstruction will herald new discussions on this front.