POSTOPERATIVE IRRADIATION FOLLOWING IMMEDIATE BREAST RECONSTRUCTION USING A TEMPORARY TISSUE EXPANDER

Ten consecutive patients at Howard University Hospital underwent modif ied radical mastectomy with immediate breast reconstruction using a te mporary tissue expander. Postoperative irradiation was delivered to th e breast mound encompassing the tissue expander. The effects of expans ion on the delivery of postoperative irradiation was assessed. Dosimet ric measurements with thermoluminescent dosimeters revealed that the s aline-filled expander attenuated the photon beam 3% less than tissue-e quivalent material of equal volume. This dose variation was negligible , so no adjustments were made. Postoperative treatment consisted of 50 40 cGy to 5220 cGy delivered in 5 to 10 weeks using 4 mV photon tangen tials. Cosmesis was assessed over a 2-year period. Six patients comple ted reconstruction and irradiation without complications. Cosmesis was good in five and fair in one. One patient developed a moist reaction secondary to postoperative irradiation; however, final cosmesis was go od. Three patients developed complications leading to the loss of the reconstructed breast. Successful final reconstruction can be achieved with careful patient selection and close follow-up by the plastic surg eon and radiation oncologist.