[abstract] USE OF HYPERBARIC OXYGEN WHEN PERFORMING REDUCTION MAMMOPLASTY IN THE PREVIOUSLY IRRADIATED BREAST

Abstract

BACKGROUND: As lumpectomy with adjuvant radiation therapy has become the treatment of choice for early-stage breast cancer,

the population of previously irradiated women who subsequently desire elective breast surgery, such as reduction

mammoplasty, is increasing. With the known risk of poor wound healing as a manifestation of delayed radiation injury, most

plastic surgeons consider prior irradiation a relative contraindication for breast reduction. Four cases previously

published in the literature describe cosmetically inferior results when reduction mammoplasty was performed in irradiated

tissue. MATERIALS AND METHODS: Retrospective chart review of 5 consecutive patients undergoing reduction mammoplasty in

previously irradiated breasts with adjuvant hyperbaric oxygen (HBO2) therapy at Virginia Mason Medical Center. As the women

had a history of unilateral radiation and underwent bilateral surgery, the non-irradiated breast served as the internal

control for each. All received 20 pre-operative HBO2 treatments, each comprising 90 min of 100% oxygen breathing at 2.36 atm

abs pressure, followed by 10 post-operative treatments on the same schedule. Extracted at chart review were demographic

data, details of malignancy and radiation therapy, pre-op and post-op LENT/SOMA breast symptom scores, time to complete

healing and final cosmetic result. RESULTS: In each case, the surgical outcome in the previously irradiated breast was a

cosmetically excellent result. Delayed healing occurred in 2 irradiated breasts (4 and 11 weeks) and 2 non-irradiated

breasts (5 and 6 weeks). The LENT/SOMA score decreased in 4 of 5 patients following treatment, remaining unchanged in a

patient with a preoperative score of 1. CONCLUSIONS: Results of reduction mammoplasty in previously irradiated breasts are

equal to those in non-irradiated breasts when adjunctive HBO2 is utilized to treat the chronic radiation injury.