Oncological aspects of breast reconstruction

Breast reconstruction has become increasingly popular over the past 20 years. There is concern that it may mask locoregional recurrence or that immediate reconstruction may compromise adjuvant treatments. We review available evidence regarding its oncological safety. The literature consists almost entirely of single institution, small retrospective reviews with variable follow-up and varying conclusions. Most reviews suggest that breast reconstruction does not adversely affect disease-free or overall survival and that there is no significant delay in presentation with recurrent disease. Three retrospective series compared chemotherapy delivery after immediate breast reconstruction with controls having mastectomy alone. No delay in chemotherapy delivery or effect on dose intensity was demonstrated. Irradiation of a prosthetic implant has been shown to increase the rate of capsular contracture; irradiation of autogenous tissue reconstruction is usually well tolerated.