title: Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant.
abstract: OBJECTIVE
  Radiotherapy (RT) has an important role in breast cancer treatment after modified radical mastectomy. Many of these patients also undergo breast reconstruction. We reviewed our institutions' experience to determine the outcome of patients treated with breast reconstruction and RT.
  
  
  METHODS
  Between 1981 and 1999, 48 breast cancer patients underwent modified radical mastectomy, breast reconstruction, and ipsilateral breast RT during their treatment course. Reconstruction either preceded or followed RT. Autologous reconstruction with a transverse rectus abdominus myocutaneous (TRAM) flap was performed in 30 patients, and 18 underwent expander and implant (E/I) reconstruction. The primary endpoint was the quality of the reconstructed, irradiated breast, as measured by analyzing the actuarial incidence of complications. The cosmetic outcome was also assessed by multidisciplinary review of the follow-up visits.
  
  
  RESULTS
  The median follow-up from reconstruction was 32 months. The actuarial 2-year complication rate was 53% for patients receiving E/I vs. 12% for those receiving TRAM reconstruction (p <0.01). No other patient or treatment-related factors had a significant impact on complications. The cosmetic outcome was also significantly better in the TRAM subgroup than in the E/I subgroup.
  
  
  CONCLUSIONS
  The tolerance and cosmetic outcome of breast reconstruction for breast cancer patients in irradiated sites depends significantly on the type of reconstruction used.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Chawla
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Zapton
authors.forename: Simon N
authors.initials: SN
authors.lastname: Powell
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015411:Mastectomy, Modified Radical / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011859:Radiography; D017568:Rectus Abdominis; D013524:Surgical Flaps / Q000009:adverse effects