Asymmetry correction in the irradiated breast: outcomes of reduction mammaplasty and mastopexy after breast-conserving therapy.

[BACKGROUND] There is relatively scant evidence concerning radiation effects on reduction mammaplasty and mastopexy, two procedures which are often used in the irradiated breast to restore symmetry following breast-conserving therapy (BCT).

[OBJECTIVE] The purpose of this study is to further examine outcomes of reduction mammaplasty and mastopexy in breast cancer patients previously treated with BCT and radiation.

[METHODS] A retrospective search at Baystate Medical Center (Springfield, MA) identified 12 patients who had received external beam radiation and either reduction mammaplasty or mastopexy. Overall radiation doses, including tumor bed boost, ranged from 5000 to 6600 cGy. The mean time between completion of radiation therapy and asymmetry correction was 63 months (range, 5 to 169 months). An overall average of 910 g of tissue was removed from the irradiated breast (range, 180 to 2925 g). The average length follow-up after asymmetry correction was 9 months (range, 1 to 44 months).

[RESULTS] In our patients, there were no major complications such as flap loss, tissue necrosis, heavy scarring, infection, or severe deformity. Minor complications in the irradiated breast occurred in 25% of patients and included prolonged edema (n = 1), delayed wound closure (n = 1), and minor scarring (n = 1). Histopathology was unremarkable except for one patient who was found to have recurrent ductal carcinoma in situ.

[CONCLUSIONS] In the cases reviewed, we did not observe any complications commonly associated with operating in an irradiated field. Good cosmesis and acceptable symmetry were achieved in all patients. Our data suggest that reduction mammaplasty and mastopexy after radiation therapy are relatively safe procedures with risks not significantly higher than either operation performed in patients without radiation.