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Ewing et al. Plast Aesthet Res 2024;11:22 Plastic and
DOI: 10.20517/2347-9264.2024.11
Aesthetic Research

Review Open Access

The radiated breast and autologous reconstruction:
benefits and alternatives

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Jane N. Ewing , Zachary Gala , Mehdi S. Lemdani, Stephen J. Kovach III, Said C. Azoury
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19103, USA.
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Authors contributed equally.
Correspondence to: Dr. Saïd C. Azoury, Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Perelman
Center for Advanced Medicine, 3400 Civic Center Blvd, 14th Floor South Building, Philadelphia, PA 19104, USA. E-mail:
Said.azoury@pennmedicine.upenn.edu

How to cite this article: Ewing JN, Gala Z, Lemdani MS, III SJK, Azoury SC. The radiated breast and autologous reconstruction:
benefits and alternatives. Plast Aesthet Res 2024;11:22. https://dx.doi.org/10.20517/2347-9264.2024.11

Received: 16 Jan 2024 First Decision: 30 Apr 2024 Revised: 27 May 2024 Accepted: 5 Jun 2024 Published: 24 Jun 2024

Academic Editor: Tine Engberg Damsgaard Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Despite advancements in research and technology, breast cancer remains the second leading cause of cancer-
related mortality affecting women worldwide. Radiation therapy is a widely recommended adjunct to surgery due
to its significant role in reducing loco-regional recurrence. Its use, however, is not without consequences. Radiation
triggers a series of pathophysiologic events leading to tissue injury; reactive oxygen species incites (1) vascular
damage and chronic hypoxia; (2) an inflammatory response; and (3) activation of myofibroblasts to induce fibrosis.
As a result, radiotherapy interferes with wound healing and negatively impacts the quality of the skin. These
pathophysiologic consequences complicate the sequence of breast reconstruction and require surgeons to
consider timing and the type of reconstruction (autologous vs. implant), with respect to radiotherapy to improve
patient outcomes. In this article, we briefly review radiation-induced tissue effects and their impact on breast
reconstruction. More specifically, we comment on the traditional use of autologous tissue, microsurgical technical
pearls for irradiated fields, reconstructive timing paradigms, and lymphedema prevention. With continued
progress, derivation, and innovation, plastic and reconstructive surgery has consistently advanced and
revolutionized both medicine and surgery. This review considers the future implications of breast reconstruction
and how it will impact patients, healthcare, and the field. While not an exhaustive review, we aim to provide a
comprehensive discussion and insights. In summary, the authors discuss the possibilities of a paradigm shift in
breast reconstruction, emphasizing the need for surgeons to have an armamentarium capable of all breast
reconstruction options for the best possible patient outcomes.

Keywords: Breast reconstruction, autologous reconstruction, radiation, radiated field, radiotherapy

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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