Outcomes of breast reconstruction in breast cancer patients with a history of mantle radiation for Hodgkin lymphoma

Ann Plast Surg. 2014 May;72 Suppl 1:S46-50. doi: 10.1097/SAP.0000000000000167.


Background: Although mantle radiation (ie, extended field radiation) represented the standard of care in the past for Hodgkin disease, contemporary treatment of lymphoma consists of a multimodal approach with chemotherapy. Patients who were exposed to mantle radiation have a higher risk of breast cancer and are more susceptible to postoperative complications after breast reconstruction due to radiation. In this study, we present postoperative outcomes in patients with a history of mantle radiation who underwent mastectomy and breast reconstruction.

Methods: All patients at Stanford University Medical Center between January 2006 and December 2012 with a history of Hodgkin lymphoma treated with mantle radiation who received breast reconstruction were identified. A retrospective chart review was conducted analyzing patient demographics, history of Hodgkin treatment, type of reconstruction, follow-up, and complications. Complications were further classified into medical complications, donor-site complications, and recipient-site complications.

Results: Sixteen patients with a history of Hodgkin disease and mantle radiation received breast reconstruction. The average age of the patients at their mastectomy was 46 (33-60) years, with the average age at the time of their mantle radiation of 20.5 (10-33) years with an average interval of radiation to breast cancer treatment of 24.8 (16-38) years. There were five unilateral and 11 bilateral reconstructions. All patients had immediate reconstruction with tissue expanders (14 patients) or autologous tissue (one muscle-sparing transverse rectus abdominis myocutaneous and one transverse upper gracilis flap). Eleven (69%) patients had postoperative complications. In the patients who had tissue expander reconstruction, there was an overall complication rate of 64%, which included capsular contracture (n=5, 56%), mastectomy flap necrosis (n=5, 56%), cellulitis (n=4, 44%), seroma (n=3, 33%), hematoma (n=1, 11%), and chronic pain (n=1, 11%). Three (two unilateral and one bilateral) tissue expander infections required removal of the expander and delayed reconstruction with a latissimus dorsi flap, whereas one patient with chronic pain and capsular contracture required a muscle-sparing transverse rectus abdominis myocutaneous for a unilateral implant failure.

Conclusions: Although the risk of complications associated with preoperative radiation is well documented, physicians and patients should be cognizant of the increased risk of complications after mantle radiation as it represents a unique modality of radiation exposure.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Breast Neoplasms / etiology*
  • Breast Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Hodgkin Disease / radiotherapy*
  • Humans
  • Mammaplasty / methods*
  • Mastectomy*
  • Middle Aged
  • Neoplasms, Radiation-Induced / surgery*
  • Postoperative Complications
  • Retrospective Studies
  • Surgical Flaps
  • Tissue Expansion
  • Treatment Outcome