Problems with radiotherapy after immediate breast reconstruction.

Smith highlights the poorer cosmetic outcomes associated with radiotherapy after immediate breast reconstruction; however, a recent study demonstrated potentially significant oncological problems. Mowtani et al.1 reported 110 patients having immediate reconstruction and post mastectomy radiotherapy, where 52% had a compromise of the radiotherapy protocol compared to only 7% of matched controls. This underlies the reluctance that many surgeons have in recommending immediate reconstruction, 52% in one UK survey.2 Those opting for immediate reconstruction have a higher incidence of psychosocial impairment and functional disability.3 In one of the few prospective studies there was no significant difference in the psychological morbidity of patients undergoing immediate or delayed reconstruction after 1 year.4 Therefore, the surgeon needs to bear this in mind when communicating the options available to the patient, who often would have preferred more time to make such a difficult decision.4 This is particularly true as we move from selecting the operation, to being a facilitator for the patient, as suggested by the increasing discussion of reconstruction with breast surgery patients from 55% in 1991 to 88% in 2000.2