Does Breast Reconstruction Affect Radiation Therapy? Examining Device Type, Placement, and Dose Effects

Area of Science:

• Oncology
• Plastic Surgery
• Radiation Oncology

Background:

• Prepectoral breast reconstruction is now more common than subpectoral placement.
• The effect of reconstruction type and device position on radiation therapy (RT) planning remains understudied.
• This study evaluates RT dose metrics and treatment timing in reconstructed versus non-reconstructed patients.

Purpose of the Study:

• To compare RT dose metrics and time to treatment.
• To analyze differences based on reconstruction type (implant vs. tissue expander [TE]) and placement (prepectoral vs. subpectoral).
• To assess the impact on heart dose, lung irradiation, dose heterogeneity, and internal mammary node (IMN) coverage.

Main Methods:

• Single-institution study of 161 patients undergoing mastectomy or lumpectomy followed by RT (2021-2024).
• Eighty patients had reconstruction (29 implants, 51 TEs); 81 did not.
• Reconstruction was prepectoral (n=41) or subpectoral (n=39). RT outcomes included heart dose, lung volume, dose "hot/cold spots," and IMN coverage.

Main Results:

• Both prepectoral and subpectoral reconstructions increased heart dose and reduced "cold spots" compared to no reconstruction.
• Subpectoral reconstruction reduced ipsilateral lung dose versus non-reconstruction.
• Prepectoral devices were linked to higher rates of IMN omission; no significant differences in time to RT, IMN coverage, TE issues, or complications were found based on device type or position.

Conclusions:

• Breast reconstruction device position or type does not significantly alter RT plan quality.
• Prepectoral reconstructions may require specific considerations for IMN treatment.
• Subpectoral reconstruction may offer benefits for lung dose reduction when IMN treatment is necessary.