Management of Radiotherapy-induced-local Surgical Complications after surgery for Breast Cancer; A Single Institute Experience

Rabie Ramadan^1, , Ahmed Shaaban¹ and Heba G. El-Sheredy²

¹Department of Surgery, Medical Research Institute, Alexandria University

²Cancer Management and Research Department, Medical Research Institute, Alexandria University

Cite this paper:
Rabie Ramadan, Ahmed Shaaban and Heba G. El-Sheredy. Management of Radiotherapy-induced-local Surgical Complications after surgery for Breast Cancer; A Single Institute Experience. Journal of Cancer Research and Treatment. 2017; 5(2):28-34. doi: 10.12691/jcrt-5-2-1

Abstract

Background: Radiation therapy (RT) is an integral component of the management of breast cancer. During RT delivery most of breast cancer patients experience adverse reactions; Most of these reactions are usually not severe enough to cause disabilities that affect their usual daily activities. Irradiation of the chest wall or reconstructed breast may result in changes in the treated soft tissues and skin that may compromise the cosmetic outcome. This study aimed to describe the management of Radiotherapy-induced-local surgical complications after surgery for breast cancer at our institution. Patients and Methods: This study included patients with breast cancer who developed radiotherapy-induced local surgical complications for which these patients were admitted to the department of Surgery, Alexandria Medical Research Institute hospital during the period between January 2015 and June 2016. The complications were classified as minor or major. The minor complications included complications which were managed conservatively or by minor surgical procedure while the major complications were those which needed reoperation for management. Results: This study included 49 patients of whom 22 patients (45%) had SSM with immediate breast reconstruction with implant, 12 patients (24.4%) had NSM with immediate breast reconstruction with implant, 10 patients (20.4%) had MRM and 5 patients (10.2%) had CBS. Thirty two patients (65.3%) developed minor complications which included capsular contracture (Baker1-2), seroma, minor skin infection and minor wound dehiscence; They were managed conservatively or by minor surgical procedures as analgesics, supporting bra, seroma aspiration, antibiotics after culture and sensitivity testing or debridement and secondary suturing. Seventeen patients (34.7%) had major complications which included capsular contracture (Baker 3-4), Severe infection, major wound dehiscence and radiation burn and/or Ulcer; they needed reoperation for management which varied between excision of all radiated skin without reconstruction and excision of all radiated skin and correction by TRAM. Conclusions: Radiotherapy-induced local surgical complications after surgery for breast cancer are not uncommon, can cause major adverse events and can occur after any type of surgery for breast cancer. Luckily; most of them are minor and can be managed conservatively or by minor surgical procedure. The oncoplastic breast surgeon should be ready to deal with these complications with different options to decrease morbidity and to regain better cosmetic outcome.

Keywords:
breast cancer breast surgery adjuvant radiotherapy capsular contracture complications

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