Consequences of Radiotherapy for Breast Reconstruction

What is the problem? The late effects of radiotherapy, which manifest from six months onwards, can have long-lasting and generally progressive and irreversible effects on normal tissues. In this chapter we will discuss the clinical effects of radiotherapy on breast reconstruction, but many of the aspects will also be relevant for other areas of reconstructive surgery for cancer. A literature review has been performed to determine the clinical impact of radiotherapy on breast reconstruction following mastectomy for breast cancer. The evidence base for clinical decision-making regarding the best scheduling of treatments and reconstruction technique will be examined. To explain the long term effects of radiotherapy on normal tissues, the underlying biological processes that radiation induces will be discussed, on the basis of our pre-clinical and translational research in this area. In particular, the effects on blood vessels and lymph vessels, inflammation and fibrosis will be highlighted, as these are relevant to reconstructive surgery following radiotherapy. Biological intervention strategies for future research to minimize the negative effects of radiotherapy on normal tissues will be described.