Postmastectomy radiation therapy (PMRT) can compromise soft-tissue quality and cause progressive fibrosis and contracture, thereby complicating delayed breast reconstruction even after prior implant removal. Delayed reconstruction is particularly challenging when radiation-associated distortion of the breast and nipple-areola complex (NAC) coexists with contralateral ptosis, because achieving symmetry requires coordinated restoration of both breast contour and nipple position. We report the case of a 50-year-old woman with invasive ductal carcinoma of the right breast who underwent nipple-sparing mastectomy followed by immediate tissue expander reconstruction with acellular dermal matrix. During adjuvant chemotherapy, she developed a periprosthetic infection that necessitated expander removal and capsulectomy. She subsequently completed PMRT, after which progressive breast contracture and severe NAC distortion developed. Ten months after completion of PMRT, delayed breast reconstruction was performed using a muscle-sparing free transverse rectus abdominis myocutaneous flap, with excision of compromised mastectomy skin, simultaneous free NAC grafting onto the flap skin paddle, and contralateral mastopexy to improve symmetry. The postoperative course was uneventful, and breast symmetry improved relative to the preoperative condition. This case illustrates a practical reconstructive option for managing severe NAC distortion in an irradiated, contracted breast after prosthetic failure.
Kim et al. (Wed,) studied this question.