title: Treatment outcome with radiation therapy after breast augmentation or reconstruction in patients with primary breast carcinoma.
abstract: BACKGROUND
  Analyses were performed to determine local control and cosmetic outcome of breast carcinoma patients with prosthetically augmented or reconstructed breasts who had received radiation therapy (RT).
  
  
  METHODS
  Twenty-one newly diagnosed breast carcinoma patients with prosthetically augmented or reconstructed breasts were treated with external beam RT. All patients received whole breast RT (median dose, 50.4 gray [Gy]) and 19 were boosted to a median dose of 60.4 Gy. A median dose of 50.4 Gy was delivered to the regional lymph nodes in 12 patients. Tissue equivalent bolus material was used in six patients. Seventeen patients received adjuvant systemic therapy. Cosmetic results were evaluated at 3-6-month intervals.
  
  
  RESULTS
  With a median follow-up of 32 months, good/excellent cosmetic results were observed in 71% of patients (100% in those with augmented breasts and 54% in those with reconstructed breasts). Four patients (19%) with fair/poor cosmetic outcomes required implant removal and/or revision. Multiple clinical and treatment-related factors were analyzed for their impact on cosmetic outcome. A worsened cosmetic result was observed with increasing stage (P = 0.076), breast reconstruction (vs. augmentation) (P = 0.030), and bolus application (P = 0.016). All patients with fair/poor cosmetic outcomes had time intervals from implant insertion to RT ranging from 53-213 days. Two patients developed an isolated local recurrence within the augmented breast.
  
  
  CONCLUSIONS
  Patients with prosthetically augmented breasts can undergo RT and expect good/excellent cosmetic results. Patients with reconstructed breasts are at a significantly greater risk for cosmetic failure. This risk may be related to the higher percentage of patients with advanced disease, those who received bolus application, and those who received earlier delivery of RT (after the cosmetic procedure) in reconstructed breasts.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Victor
authors.forename: D M
authors.initials: DM
authors.lastname: Brown
authors.forename: E M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: A A
authors.initials: AA
authors.lastname: Martinez
authors.forename: V R
authors.initials: VR
authors.lastname: Kini
authors.forename: J E
authors.initials: JE
authors.lastname: Pettinga
authors.forename: K W
authors.initials: KW
authors.lastname: Shaheen
authors.forename: P
authors.initials: P
authors.lastname: Benitez
authors.forename: P Y
authors.initials: PY
authors.lastname: Chen
authors.forename: F A
authors.initials: FA
authors.lastname: Vicini
mesh_terms: D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D011830:Radiation Effects; D012189:Retrospective Studies; D016896:Treatment Outcome