A 50-year-old woman undergoes skin-sparing mastectomy for right breast carcinoma. She opts for immediate implant-based reconstruction. Postoperatively she requires adjuvant radiation therapy. What is the most significant oncoplastic consideration?

• A Radiation is contraindicated with implant-based reconstruction
• B Two-stage expander-implant is recommended only after radiation is completed
• C Fat grafting eliminates radiation-related capsular contracture
• D Radiation after immediate implant reconstruction increases capsular contracture and implant failure rates ✓

Explanation

Post-mastectomy radiation therapy (PMRT) delivered to an immediate implant-based reconstruction significantly increases rates of capsular contracture (Baker grade III–IV), implant failure, infection, and poor cosmetic outcome compared to autologous reconstruction. This is a major limitation of implant-based immediate reconstruction in patients anticipated to need PMRT. Options include: delayed immediate reconstruction (place tissue expander → irradiate → exchange to implant or autologous flap), or autologous reconstruction (TRAM, DIEP, LD flap) which is more radiation-tolerant. Fat grafting may partially improve radiation-damaged tissue but does not eliminate contracture.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.