[Forum on tissue expansion. Are tissue expansion and radiotherapy compatible? Apropos of a series of 50 consecutive breast reconstructions].

Tissue expansion has become a method of choice for immediate or delayed breast reconstruction. The compatibility of radiotherapy and tissue expansion is a growing problem. We analyse a series of 50 breast reconstructions by expansion, 24 without radiotherapy and 26 with radiotherapy. For the 24 patients without radiotherapy, very satisfactory cosmetic results were obtained in 71% of cases with 21% of stage III-IV capsular contractures and 8% of failures. For the 26 patients with a history of radiotherapy, very satisfactory cosmetic results were obtained in 65% of cases with 20% of capsular contractures and 10% of failure. 20% of cases also required a myocutaneous flap to complete the reconstruction. The complications related to radiotherapy are due to radiation lesions of endovasculitis and destruction of the network of elastin fibres. They result in the impossibility of filling the expander, deformation of the thoracic cage, expansion without projection, thinning of the tissues over the prosthesis and necrosis and exposure requiring the use of a myocutaneous flap. In conclusion, signs of radiation dermatitis constitute a contraindication to tissue expansion, which is nevertheless possible, but with a higher risk of complications. Irradiation to an expansion prosthesis is associated with an unacceptable complication rate.