What question did this study set out to answer?

This study aims to evaluate the interaction of reconstructive and radiation therapy parameters on surgical complications and treatment delays.

February 5, 2026

The Relationship of Radiation Therapy Parameters and Perioperative Morbidity and Toxicities on Breast Reconstruction Outcomes

Key Points

This study aims to evaluate the interaction of reconstructive and radiation therapy parameters on surgical complications and treatment delays.
Analyzed a single-center retrospective cohort of women postmastectomy with immediate reconstruction and PMRT from 2017-2022.
Assessed complications categorized by timing: pre-RT, intra-RT, and post-RT.
Utilized generalized estimating equation logistic models to estimate associations between clinical and radiation factors and complications.
144 patients underwent 260 mastectomies with 152 receiving PMRT.
About 25% experienced adverse surgical outcomes before and after PMRT.
No significant delays in PMRT initiation were linked to pre-RT complications or severe dermatitis.
Intensity-modulated RT and proton therapy were associated with fewer cases of severe dermatitis compared to conventional methods.

Abstract

Background Postmastectomy radiation therapy (PMRT) is a key component of breast cancer care, reducing locoregional recurrence in appropriately selected patients. Concurrently, use of mastectomy with implant-based breast reconstruction has expanded, heightening attention to how patient, surgical, and radiation factors interact. There is a knowledge gap in how reconstructive strategies and PMRT parameters jointly influence complications, toxicities, and treatment timing across the expander-implant continuum. Objective The aim of this study was to determine how reconstructive and radiation therapy (RT) parameters relate to surgical-site complications, delays in PMRT initiation, acute radiation toxicities, delays in expander-to-implant exchange, and capsular contracture. Methods This study examined a single-center retrospective cohort of women undergoing mastectomy with immediate tissue expander or direct-to-implant reconstruction and PMRT (2017–2022). Complications classified as postmastectomy pre-RT, intra-RT, and post-RT. Associations between clinical and radiation factors and complications, toxicities, and delays were estimated using generalized estimating equation logistic models. Results One hundred forty-six patients underwent 260 mastectomies, and 152 reconstructions received PMRT. The majority underwent dual-stage reconstruction (87.5%). Adverse surgical site outcomes occurred in approximately one-quarter of breasts before PMRT and in a similar proportion after PMRT. Neither pre-RT surgical site outcomes delayed PMRT ( P = 0.61) nor did severe dermatitis delay expander-to-implant exchange ( P = 0.63). Severe dermatitis was less frequent with intensity-modulated RT ( P < 0.01) and proton therapy ( P < 0.02) than with three-dimensional conformal RT, whereas bolus use increased the risk of dermatitis ( P < 0.01). Severe capsular contracture occurred less frequently after prepectoral versus submuscular reconstruction, but the difference did not reach statistical significance ( P = 0.30). Conclusions In an integrated care setting where PMRT and reconstruction are performed in the same institution, pre-RT complications do not correlate with delaying PMRT, nor do post-RT complications or acute toxicities alter the implant exchange course. Complications were substantial during the pre-RT period, suggesting further opportunities for improvement. These findings emphasize the importance of multidisciplinary planning/communication to optimize patient treatment and outcomes.

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