The impact of adjuvant radiotherapy on complications among who underwent delayed breast reconstruction

Background. Рostmastectomy radiation therapy (PMRT) is one of the causes of complications in patients with breast cancer after delayed breast reconstruction (DBR). Aim. To conduct a retrospective analysis of DBR outcomes and evaluate the impact of PMRT on the frequency and nature of complications. Materials and methods. Data from 178 patients with breast cancer who underwent DBR at N. N. Petrov National Medical Research Oncology Center, from 2015 to 2021 were included. In 87 patients, PMRT was administered to the soft tissues of the anterior chest wall and regional lymph nodes (group 1). Reconstruction with tissue expanders was performed in 66 (75.9 %), women while 1 (1.1 %) patient received a permanent implant. Six (6.9 %) patients underwent combined reconstruction using an expander with a thoraco-dorsal flap (TDF). In five (5.7 %) cases, a permanent implant was combined with TDF. Autologous reconstruction techniques were used in 10.3 % of cases (9 patients). Among the remaining 91 women PMRT was not performed (group 2). In this group, 69 (75.8 %) patients underwent reconstruction with tissue expanders, 2 (2.2 %) patients received permanent implants, 10 (11 %) patients had implants combined with TDF, and the combination of tissue expander with TDL was used in 2 (2.2 %) patients. Eight (8.8 %) patients underwent autologous reconstruction. Complications were assessed based on data from the medical information system “Vista” and telephone surveys and were determined as reconstructive failure (RF) and capsular contracture (CC) of Baker grades III–IV. Results. The mean follow-up duration was 48 months [14.5; 89.0] in the PMRT group and 63 months [38; 94] in the non-PMRT group. The overall complication rate was 27.5 % (49 cases), including reconstructive failures in 23 % (41 cases) and clinically significant СС (Baker III–IV) in 4.5 % (8 cases). RF occurred in 29.9 % of patients who received PMRT versus 16.5 % in those who did not (p = 0.03). The incidence of CC did not differ significantly: approximately 4.6 % in the PMRT group versus 4.4 % in the non-PMRT group (p = 0.95). Among patients who received PMRT after reconstruction with tissue expander RF were higher (33.3 %) compared to 14.5 % in non-irradiated patients (p = 0.01). Complications following autologous reconstruction occurred frequently regardless of PMRT status and probably were associated with the ability of surgery. Conclusion. Radiotherapy increases the risk of RF after DBR but was not associated with the risk of CC. Our data highlight the need to consider the impact of PMRT when planning DBR.