Priority 5 from the Post Mastectomy Breast Reconstruction PSP

UNCERTAINTY: How does radiation therapy affect breast reconstruction including the optimal wait time? (JLA PSP Priority 5)
Overall ranking	5
JLA question ID	0109/5
Explanatory note	Radiation therapy may be indicated in addition to the surgical treatment of the breast. Radiation may have occurred before or after surgical treatment such as lumpectomy or mastectomy. Radiation has been shown to have an adverse effect on breast reconstruction aesthetic outcomes. In implant reconstruction, radiation can worsen scarring and the formation of capsular contracture. In tissue reconstruction, radiation can cause soft tissue atrophy and muscle fibrosis. It is not currently known whether radiation therapy yields worse long-term aesthetic results when it is delivered prior to or following mastectomy. Furthermore, in a patient who has opted to undergo delay breast reconstruction and had prior radiation, it would be useful to determine if there is an optimal length of time to wait before delayed reconstruction can take place with minimal short and long-term complications.
Evidence	Early and locally advanced breast cancer: diagnosis and management. Evidence-based recommendations on diagnosing and managing early and locally advanced breast cancer. Breast cancer reconstruction surgery (immediate and delayed) across Ontario: patient indications and appropriate surgical options. Cancer Care Ontario's Program in Evidence-based Care
Health Research Classification System category	Cancer

Extra information provided by this PSP
Original uncertainty examples	I am not sure I understand this question in the context of being a plastic surgeon. The question of if/when to do reconstruction in the setting of radiotherapy continues to be one that needs examination. ~ How long do you have to wait after radiation for reconstruction surgery to get good outcomes. ~ Would like to know more about length of time surgery is delayed after radiation
Submitted by	4 x Patients and Care-givers, 1 x Clinician

PSP information
PSP unique ID	0109
PSP name	Post Mastectomy Breast Reconstruction
Total number of uncertainties identified by this PSP.	86 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	2 July 2019