title: Postmastectomy radiation therapy and immediate autologous breast reconstruction: integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery.
abstract: OBJECTIVE
  The effect of postmastectomy radiation therapy (PMRT) on immediately reconstructed abdominal wall-based tissue remains imprecisely defined. We evaluated evidence from all fields involved in care of the breast cancer patient in order to advance a unified recommendation regarding this therapeutic sequence.
  
  
  METHODS
  We performed a MEDLINE and manual reference search to identify studies of PMRT with immediate autologous breast reconstruction. Inclusion criteria required studies to describe patients, flaps, and complication rates. Analyses were based on a random effects model. Surgical and radiation oncology literature was reviewed.
  
  
  RESULTS
  Eleven retrospective studies of 337 patients with an average follow-up of 18-60 months (out of 268 patients) were selected for inclusion. Overall rates of fat necrosis, revisional surgery, volume loss, and fibrosis/contracture ranged from 16.9% to 35.4%. One out of 260 patients experienced total flap loss. There was an increased probability of fat necrosis in the irradiated breast (OR = 3.13, 95% CI = 1.42-6.89, P = 0.005) among three studies with non-irradiated controls. Five studies evaluated aesthetics with variable outcomes.
  
  
  CONCLUSIONS
  There is mixed evidence for the utility of PMRT with immediate autologous abdominal wall breast reconstruction. Further investigation requires prospective studies with collaboration among surgical oncologists, radiation oncologists, and plastic surgeons.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Rochlin
authors.forename: Ah-Reum
authors.initials: AR
authors.lastname: Jeong
authors.forename: Leah
authors.initials: L
authors.lastname: Goldberg
authors.forename: Timothy
authors.initials: T
authors.lastname: Harris
authors.forename: Kriti
authors.initials: K
authors.lastname: Mohan
authors.forename: Stella
authors.initials: S
authors.lastname: Seal
authors.forename: Joe
authors.initials: J
authors.lastname: Canner
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy / Q000009:adverse effects*; D015201:Meta-Analysis as Topic; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D018787:Radiation Oncology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies
keywords: autologous tissue; breast reconstruction; complications; radiotherapy