Abstract
Background Delayed autologous breast reconstruction is commonly recommended in patients requiring
postmastectomy radiation. This study examines gross and histologic changes in the
breast skin of patients who have undergone postmastectomy radiation to help determine
when radiation-induced skin changes begin to stabilize.
Methods A prospective pilot study was conducted on eight patients with invasive breast cancer
who required mastectomy and radiotherapy. At the time of mastectomy and 2, 4, 6, 8,
and 12 months after completion of radiotherapy, a punch biopsy was taken from the
radiated mastectomy skin of each patient. Serial standardized photographs were taken
before and after radiotherapy to evaluate the degree of hyperpigmentation and graded
by three blinded plastic surgeons. Skin biopsies were processed for histologic assessment
of inflammation, elastin organization, and vascularity.
Results Grading of patient photographs revealed an increase in hyperpigmentation after radiotherapy
compared with baseline with a gradual improvement over time. SMAD3 immunostaining
demonstrated a trend toward an increase in inflammation over 12 months. The elastin
distribution within samples showed an increase in fiber disorganization, thickening,
and clumping, with no improvement throughout the study period. The average number
of vessels per high powered field decreased steadily through the duration of the study.
Conclusion Histologic changes in dermal inflammation, elastin organization, and vascularity
do not appear to correspond with the gradual improvement of hyperpigmentation, resulting
from postmastectomy radiation. These histologic changes persist beyond the 12 month
observation period and will require clinical correlation to determine the potential
impact on postoperative outcomes.
Keywords
delayed breast reconstruction - postmastectomy radiation therapy - radiation skin
changes
