INTRODUCTION

Post-mastectomy radiotherapy has become increasingly common for patients with advanced breast cancer since the initial indications were first described by Ragaz and Overgaard in 1997.1-3 Breast reconstruction has also become more frequent with the most common technique being two stage-prosthetic reconstruction.4 The optimal timing and sequence of mastectomy, reconstruction, adjuvant chemotherapy and radiotherapy remains unresolved. If there is insufficient time to undergo the exchange procedure before radiation starts, then patients must receive radiation to the tissue expander (TE). Alternatively, radiation may be delivered to the permanent implant following the exchange procedure and completion of chemotherapy.5, 6 Results associated with these two algorithms demonstrate variable outcomes and have focused principally on surgical outcomes such as loss of the TE or permanent implant, and overall reconstructive failure. A systematic review demonstrated that studies in the literature are limited by a small case number, retrospective nature, absence of a control group, and omission of aesthetic outcomes and patient satisfaction.7
The senior author (P.G.C) has maintained a prospective database of two-stage prosthetic reconstruction that includes short-term complications, long-term outcomes, aesthetic results including capsular contracture, and more recently patient-reported outcomes. The objective of this study is to assess this prospectively collected data to evaluate and compare both clinician and patient-reported outcomes using two different algorithms: radiation of the TE followed by the exchange procedure versus radiation to the permanent implant after the exchange procedure. A group of non-irradiated patients was included as a control group.