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Invited Critique
September 2010

Start by Decreasing Unnecessary Postmastectomy IrradiationComment on “Using Complications Associated With Postmastectomy Radiation and Immediate Breast Reconstruction to Improve Surgical Decision Making”

Author Affiliations

Author Affiliation: Breast Surgical Clinic, Swedish Cancer Institute, Seattle, Washington.

Arch Surg. 2010;145(9):878-879. doi:10.1001/archsurg.2010.171

The Christante et al article describes the effect of IRB and postmastectomy chest wall irradiation on postmastectomy complication rates. For patients with no reconstruction, complication rates rose with PMRT from 3% to 7%. For delayed reconstruction, complication rates rose with PMRT from 0 of 12 patients to 2 of 9 patients. For the patients who underwent IRB, complication rates rose with PMRT from 16% (16 of 98) to 42% (14 of 33). To avoid IRB in patients who will have PMRT, they suggest doing IRB only in SLNB-negative patients and those with T1 tumors. Unfortunately, they do not provide the preoperative primary tumor and SLN information to validate this recommendation. The recommendation is too restrictive and would require all potential IRB patients to have an additional operation prior to mastectomy.

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