Radiotherapy and breast reconstruction after surgical treatment of breast cancer.

Considering the psychosocial benefits obtained with immediate breast reconstruction (IBR)1, this procedure has been increasingly applied in Brazil, mainly in the immediate surgical context. The two main modalities of IBR used are the ones that employ autogenous tissue or artificial breast implants or expanders. There is no consensus regarding the ideal time to carry out the IBR within the multimodal context of oncological treatment, especially when there is indication of radiotherapy (RT) after the mastectomy – which depends on the surgical specimen – and also considering the lack of randomized studies comparing RT preand post-plasty. There is a rationale followed by many large American centers, to choose RT before IBR for two main reasons: After the procedure, tissue that does not belong to the breast bed (muscle flaps, skin and prosthesis) would be irradiated without need. The IBR carried out before the RT can lead to inadequate planning, either with excessive irradiation of adjacent organs, or insufficient irradiation of the surgical bed and/or lymph node draining. Other obstacles to be faced are related to the size of breast reconstruction that is carried out, which very often modifies the patient’s anatomy due to the large-volume plasty and the use of expanders with metallic components within the irradiation field, which can result in regions of under and overdose2, clinically translating as a higher chance of developing complications after the RT. Moreover, breast medialization, symmastia and flat chest naturally impair radiotherapy planning. On the other hand, in addition to the aforementioned psychological gain with the immediate breast reconstruction, another justification by those supporting this technique is that RT can compromise the skin and subjacent tissue quality, thus impairing the plasty, consequently affecting the cosmetic results3. In this context, complications can arise after IBR folGustavo Nader Marta1, saMir abdallah haNNa2, eduardo Martella3, João luis FerNaNdes da silva4