Adjuvant therapy and breast reconstruction

Given reports of the increased risk of capsular contracture associated with radiotherapy and implant reconstruction and the need for removal or reoperation despite reported acceptable cosmetic results, we recommend autologous tissue-based reconstruction instead of implant reconstruction in patients who have received or will receive radiotherapy. Ideally, delaying reconstruction until after radiotherapy is prudent and results in less morbidity. In addition, if a patient receives radiotherapy and desires delayed reconstruction, we believe that autologous tissue provides the most reliable and best aesthetic results. Although many centers have reported minimal complications and acceptable cosmetic results in patients who receive radiotherapy after autologous tissue-based reconstruction, we believe this risk is unnecessary. Delaying reconstruction until after radiotherapy decreases the risk of fat necrosis, volume loss, and the need for additional flaps. Furthermore, immediate reconstruction may cause technical problems when designing the radiation fields necessary to deliver adjuvant radiotherapy.