Related Experiment Video
Updated: Mar 20, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Early radiation effects on immediate breast reconstruction: A comparative analysis of 15- and 5-fraction
Sarah Omar1,2, Abdou M A Darwish1, Krzysztof Sosnowski3
1Department of Plastic Surgery, Minia University Hospital, Kornish El Nile Street, Minia, Egypt.
Background:
Modern postmastectomy radiotherapy (PMRT) increasingly employs ultra-hypofractionated regimens (26 Gy/5 fractions) as an alternative to standard hypofractionation (15 fractions/40-42 Gy). However, evidence on their safety in the reconstructive setting remains limited. This study compares acute toxicity outcomes between these regimens and a non-irradiated control group following immediate breast reconstruction.
Methods:
A single-center cohort study included 203 immediate breast reconstructions in 168 patients (implant = 59, DIEP = 47, LD = 33, BCS = 64) performed between July 2024 and July 2025. Patients received either 3-week (n = 63) or 5-day (n = 50) PMRT, or no radiotherapy (n = 90). Acute toxicity (≤3 months) was graded using the RTOG/EORTC scale. Kruskal-Wallis and ordinal logistic regression models were used to assess the influence of radiotherapy exposure, dose, and reconstruction type on toxicity severity and intervention requirements.
Results:
Across the cohort, most reconstructions exhibited mild toxicity (47.8%), with more severe reactions (Grade 3-4) limited to 7.4% of cases. Radiotherapy exposure significantly increased toxicity severity (H = 30.8, p < .001), whereas differences between 3-week and 5-day regimens were non-significant (p > .05). Regression models confirmed RT exposure, particularly conventional 3-week fractionation, was the main predictor of higher RTOG/EORTC scores (p < .001), while reconstruction type alone had no significant independent effect. The 5-day regimen had a comparable acute toxicity profile to the 3-week regimen.Erythema and oedema were the most frequent manifestations, both predominantly low-grade. Intervention rates were low across groups (<7%), and no increase in acute surgical management was observed with ultra-hypofractionated RT.
Conclusions:
Both 5-day and 3-week PMRT regimens were associated with mild, self-limiting acute toxicity, with no evidence of higher complication or intervention rates using ultra-hypofractionation. These findings support the 5-fraction schedule as a safe, efficient alternative to standard PMRT in appropriately selected reconstruction patients with a comparable, if not milder, acute toxicity profile. Long-term follow-up is warranted to evaluate chronic effects and reconstructive durability.
