Expert Point of View: Amber Orman, MD




This study provides guidance when deciding how best to integrate postmastectomy reconstruction and radiation therapy.
— Amber Orman, MD

Amber Orman, MD, of the Department of Radiation Oncology, Breast Section, at Moffitt Cancer Center in Tampa, Florida, who was not involved in this study, said: “This study provides guidance when deciding how best to integrate postmastectomy reconstruction and radiation therapy. This is an area with no real standard of care, and the approach can vary from institution to institution. This study reveals that complications were increased in patients requiring radiation therapy after implant-based reconstruction. There was no increase in complications in those requiring radiation after autologous reconstruction.”

Dr. Orman continued: “Patients and physicians now have more data to use when formulating a plan for reconstruction in the setting of radiation. This is incredibly valuable data, as many patients require radiation therapy after mastectomy.”

Tufia Haddad, MD, a medical oncologist at the Mayo Clinic, ­Rochester, Minnesota, who also was not involved in the study, said: “We have been starving for data like this, so we can better counsel our patients in terms of potential risks. We don’t always know when patients go to the operating room whether they will need radiation. Sometimes it is surprising to hear they have positive nodes.”


I don’t know if this will shift patients toward autologous reconstruction and away from implants, but if a patient has options, these data may influence her selection.
— Tufia Haddad, MD

“The study found striking differences in complications, with implants having higher rates and autologous reconstruction having lower rates. The truth is this study gives us hard data. It is beautifully designed,” Dr. Haddad said.

Clinical Implications

When asked whether this study will have an effect on patients’ choice of reconstruction technique, Dr. ­Haddad was unsure. “I don’t know if this will shift patients toward autologous reconstruction and away from implants, but if a patient has options, these data may influence her selection. It’s a personal choice,” Dr. ­Haddad continued.

“Delayed reconstruction would enable radiation to prevent local relapse and improve survival. I hate to see a patient decline radiation because she is worried about not being able to have reconstruction and a good cosmetic outcome,” Dr. ­Hadded commented. ■

Disclosure: Drs. Orman and Haddad reported no potential conflicts of interest.


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