Comparison of Aesthetic Breast Reconstruction After Skin-Sparing or Conventional Mastectomy in Patients Receiving Preoperative Radiation Therapy

In Brief Many options exist for the surgical treatment of breast cancer in terms of tumor extirpation and reconstruction. Skin-sparing mastectomy (SSM) with immediate reconstruction offers patients a superior result, but this can be jeopardized by preoperative radiotherapy. We compared the outcomes of reconstruction after SSM or conventional mastectomy (CM) in the previously irradiated breast. We evaluated 41 patients over an 8-year period, who were divided into 3 categories: preoperative radiotherapy prior to SSM (n = 8), CM after preoperative radiation therapy (n = 9), and no chest wall irradiation prior to SSM (n = 20). The first group demonstrated significantly higher frequency of native flap compromise and capsular contracture formation than the other 2 groups. SSM with TRAM or latissimus with implant reconstruction is an esthetically optimal option for the treatment of patients without previous radiotherapy. However, for patients with preoperative chest wall radiation, TRAM flap reconstruction was superior to latissimus flap with implant after SSM. A retrospective study of 41 immediate breast reconstructions demonstrated a higher rate of native flap compromise and capsular contracture post-radiation with skin-sparing mastectomy than with conventional mastectomy. In addition, TRAM reconstructions were seen to be superior to latissimus/implant reconstructions in irradiated patients.