Reconstructive plastic surgery with an expander / implant and radiation therapy for breast cancer

Breast cancer maintains its leading position in the structure of oncological diseases in the world among the female population. Surgical treatment is one of the main methods of treatment, both in monotherapy and in the complex / combined treatment of this disease. Modern methods and technologies make it possible to restore the removed mammary gland by performing reconstructive plastic surgery using implants or autologous tissues. Reconstruction using tissue expanders is one of the best options for patients who receive radiation therapy. Conformal radiation therapy leads to an increase in survival rates in patients, including those with reconstructive plastic surgery. However, patients can experience complications (capsular contracture, implant exposure, infectious complications, etc.) and unsatisfactory aesthetic results, arising after radiation therapy on a tissue expander / implant. The literature review describes the criteria for the selection and administration of patients during treatment, which will reduce the risks of the described complications. These criteria include: time of radiation therapy (neoadjuvant or adjuvant radiation therapy), the time of replacement of the tissue expander with an implant, body mass index (BMI), age of patients, as well as the effect of adjuvant chemotherapy. According to the literature data, the frequency of complications after the secondstage of reconstructive surgery does not differ in dependence of whether it is performed before or after radiation therapy. BMI of less than 30 and age under 50 are optimal indicators for a successful two-stage reconstruction followed by radiation therapy. Slightly higher incidence of infection has been observed in patients who had their tissue expander replaced with a permanent anatomical implant earlier than 4 months after radiation therapy; a higher incidence of capsule contracture has been recorded in patients who had the operation performed later than 4 months after radiation therapy. High quality of life, oncological safety and aesthetic results are the main tasks of surgeons performing reconstructive plastic surgery using an implant / expander.Planning for radiation therapy after these operations must be done by radiotherapists together with surgeons, taking into account all the features and possible risks of this stage of treatment.