A pilot study of assessing surgical morbidity of preoperative radiotherapy in women undergoing whole breast reconstruction

This study intends to assess preoperative radiotherapy (RT)’s viability and surgical risk in women having mastectomy followed by immediate autologous whole breast reconstruction. Patients with breast cancer who need both a mastectomy and radiation therapy are eligible, as determined by multidisciplinary team decisions. Two to four weeks following the last round of neoadjuvant chemotherapy, preoperative radiotherapy is administered using either IMRT or conventional methods, with treatment volumes encompassing the breast and regional nodes as necessary. To allow for recovery and lower the risk of fibrosis, surgery is planned 4–6 weeks after RT and involves mastectomy and DIEP flap reconstruction. Because of the increased risk of necrosis after preoperative RT, intraoperative use of indocyanine green (ICG) helps evaluate the viability of skin flaps. According to institutional protocols, standard systemic therapies are still being used. Assessments of surgical outcomes, wound healing (using Clavien-Dindo and CDC criteria), patient-reported outcomes (BREAST-Q), cosmetic results, and documentation of complications like flap failure or infection are performed on patients at regular intervals for up to a year. Prior to a planned randomized controlled trial, the study aims to produce preliminary data regarding the safety and feasibility of preoperative RT in this context.