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Background <p>Although postmastectomy radiation therapy (PMRT) is a standard treatment for high-risk breast cancer, it adds the risk of complications after breast reconstruction (BR).</p> Methods <p>This multi-institutional cohort study included patients with stage II–III breast cancer—defined as tumor size ≥ 5&#xa0;cm, lymph node involvement, and/or skin/chest wall invasion—who underwent immediate or delayed BR after mastectomy between January 2008 and December 2018. We retrospectively investigated the relationship between PMRT and BR-related complications after adjusting for patient characteristics and BR method.</p> Results <p>Among 1138 patients (1101 immediate and 37 delayed BR), 427 (37.5%) underwent PMRT. The cohort included 238 (20.9%) patients with tumors ≥ 5&#xa0;cm, 725 (63.7%) with 1–3 lymph node metastases, and 257 (22.6%) with ≥ 4. BR methods included 750 prosthetic, 385 autologous, and 3 fat graft procedures. The overall complication rates were 25.2% and 31.5% in the non-PMRT and PMRT groups, respectively (<i>p</i> = 0.028). In prosthetic BR, capsule contracture (<i>p</i> &lt; 0.001) and infection (<i>p</i> = 0.014) were more frequent in the PMRT than the non-PMRT group, whereas no significant difference was observed in complication rates between two groups in autologous BR. Multivariate analysis identified PMRT as an independent risk factor for BR-related complications (odds ratio, 1.47; <i>p</i> = 0.032). The reoperation rate was similar in two groups.</p> Conclusions <p>PMRT was associated with an increased incidence of BR-related complications in prosthetic BR, but not with reoperation, irrespective of the reconstruction method.</p>

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Breast reconstruction-related complications from postmastectomy radiation therapy in stage II–III breast cancer: sub-analysis of a multi-institutional observational study (Reborn-03)

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  • 发表日期：

    2025年11月18日

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  • Shinsuke Sasada,
  • Wakako Tsuji,
  • Noriyuki Watanabe,
  • Ayaka Shimo,
  • Natsue Uehiro,
  • Takahiro Tsukioki,
  • Naomi Nagura,
  • Shoichi Tomita,
  • Hiroko Nogi,
  • Kei Yamaguchi,
  • Kazuhiko Yamagami,
  • Akiko Ogiya,
  • Hiromi Suetsugu,
  • Yuki Nakamura,
  • Chikako Yamauchi,
  • Hirohito Seki

摘要

Background

Although postmastectomy radiation therapy (PMRT) is a standard treatment for high-risk breast cancer, it adds the risk of complications after breast reconstruction (BR).

Methods

This multi-institutional cohort study included patients with stage II–III breast cancer—defined as tumor size ≥ 5 cm, lymph node involvement, and/or skin/chest wall invasion—who underwent immediate or delayed BR after mastectomy between January 2008 and December 2018. We retrospectively investigated the relationship between PMRT and BR-related complications after adjusting for patient characteristics and BR method.

Results

Among 1138 patients (1101 immediate and 37 delayed BR), 427 (37.5%) underwent PMRT. The cohort included 238 (20.9%) patients with tumors ≥ 5 cm, 725 (63.7%) with 1–3 lymph node metastases, and 257 (22.6%) with ≥ 4. BR methods included 750 prosthetic, 385 autologous, and 3 fat graft procedures. The overall complication rates were 25.2% and 31.5% in the non-PMRT and PMRT groups, respectively (p = 0.028). In prosthetic BR, capsule contracture (p < 0.001) and infection (p = 0.014) were more frequent in the PMRT than the non-PMRT group, whereas no significant difference was observed in complication rates between two groups in autologous BR. Multivariate analysis identified PMRT as an independent risk factor for BR-related complications (odds ratio, 1.47; p = 0.032). The reoperation rate was similar in two groups.

Conclusions

PMRT was associated with an increased incidence of BR-related complications in prosthetic BR, but not with reoperation, irrespective of the reconstruction method.