title: Does postoperative radiation therapy represent a contraindication to expander-implant based immediate breast reconstruction? An update 2012-2014.
abstract: OBJECTIVE
  Post-mastectomy radiotherapy (PMRT) is well known in the plastic surgery community for having a negative impact on expander-implant based immediate breast reconstruction (IBBR), although recently some technical improvements allow better results. Very recent papers would suggest that there is no difference in postoperative complications in patients receiving post-mastectomy radiotherapy using modern techniques. However, study results are often biased by small groups of patients and by heterogeneity of radiotherapy timing, different surgical techniques and measured outcomes.
  
  
  METHODS
  We have conducted a MEDLINE search to summarize the latest data (2012-2014) on the topic. Search was conducted using the following parameters: breast reconstruction AND implant AND expander AND post-mastectomy radiotherapy.
  
  
  RESULTS
  The MEDLINE search showed 53 reports, demonstrating a great interest on this topic; among these 37 dealed specifically with post-mastectomy radiotherapy after breast reconstruction. In particular, 15 were amenable to plastic surgeons, 6 to breast surgeons, 9 to radiotherapists and 7 to oncologists. Papers amenable to plastic surgeons highlighted the highest rate of undesired results, although with recent advances such as delayed-immediate reconstruction or protective lipofilling.
  
  
  CONCLUSIONS
  PMRT remains an undesired event when pursuing an implant-based breast reconstruction, although it does not represent an absolute contraindication. The higher rate of complications reported by plastic surgeons and not by other specialists can be explained with the greater attention to aesthetic details, such as capsular contractures, that our community has. Technical strategies to prevent complications described in this community now allow better results, should be well known and improved if possible in the future.
authors.affiliation: Unit of Plastic and Reconstructive Surgery, Department of Surgery, "Sapienza" University, Rome, Italy. ambramonfrecola@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Ribuffo
authors.forename: A
authors.initials: A
authors.lastname: Monfrecola
authors.forename: M
authors.initials: M
authors.lastname: Guerra
authors.forename: G M
authors.initials: GM
authors.lastname: Di Benedetto
authors.forename: L
authors.initials: L
authors.lastname: Grassetti
authors.forename: E
authors.initials: E
authors.lastname: Spaziani
authors.forename: T
authors.initials: T
authors.lastname: Vitagliano
authors.forename: M
authors.initials: M
authors.lastname: Greco
mesh_terms: D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D015626:Tissue Expansion / Q000009:adverse effects / Q000379:methods*; D015625:Tissue Expansion Devices / Q000009:adverse effects