[en] Introduction: Up to a third of patients with breast cancer require mastectomy, after which postmastectomy reconstruction (PMR) is usually offered. A subgroup of patients will require the administration of postoperative radiotherapy to the chest wall (PMRT), as a benefit in disease-free and overall survival has been demonstrated. The choice of the PMR technique and when to perform it are controversial due to the eventual post-surgical complications involved in irradiating the reconstructed chest wall. Currently, there is no type I evidence available on what is the best reconstruction, sequence, or acceptable time between one procedure and another when it is performed differently, so it continues to be an institution-dependent management. Objectives: To determine the possible relationship between the appearance of complications with and without PMRT after RPM, in terms of: 1) specific morbidity; 2) breast cancer recurrence rate; 3) morbidity depending on the moment of RPM (immediate vs. delayed); 4) morbidity depending on the reconstruction technique (autologous vs. heterologous) and 5) systemic treatment, hormone therapy, volume of the prosthesis and target volumes of radiotherapy. Material and Methods: Observational, retrospective and single-center clinical study, based on the analysis of a database of 273 patients diagnosed with breast carcinoma treated by mastectomy and exclusive reconstruction or with associated adjuvant radiotherapy, between the years 2016 and 2020. at the Virgen de la Arrixaca University Clinical Hospital in Murcia, and with a minimum follow-up period of two years. A descriptive and comparative study was carried out between the groups with and without PMRT with respect to a series of variables (demographic, anatomopathological, treatment and follow-up), and statistical analysis was carried out. Results: After a median follow-up of 65 months, 42.1% of the cases developed some type of associated morbidity, with no differences between those who received RTPM and those who did not (62.6% vs 37.4%, p=0.146). Among the complications, 55,7% were reconstructed by immediate PMR, 23,5% delayed, and 20,9% immediate-delayed (p=0.027). Regarding complications according to technique, autologous PMR was performed in 27% and heterologous in 73% (p<0.001). 59.6% relapsed at different levels, observing a trend towards statistical significance in favor of PMRT (p=0.063). The median survival was 44.50 months and 35 months (PMRT and no PMRT, respectively, p=0.809). No correlation was found between the incidence of complications and PMRT according to the administration of chemotherapy, hormone therapy or addition of axillo- supraclavicular lymph node volumes, although it was found with prosthetic volumes equal to or greater than 300cc (p=0.057). Conclusions: No specific correlation has been found between the administration of PMRT and complications after PMR. However, a significant increase in them has been observed in heterologous reconstructions and in those performed immediately. A worse evolution has also been observed when the prosthetic volumes are greater than 300cc, although not when the radiotherapy volumes include the lymph node areas, in addition to the mastectomy bed.

[es] Introducción: Hasta un tercio de las pacientes con cáncer de mama requieren mastectomía, tras la cual, se suele ofrecer la reconstrucción postmastectomía (RPM). Un subgrupo de pacientes precisará la administración de radioterapia postoperatoria sobre la pared torácica (RTPM), al haberse demostrado beneficio en supervivencia libre de enfermedad y global. La elección de la técnica de RPM y el momento de realización de la misma aspectos son controvertidas debido a las eventuales complicaciones postquirúrgicas que conlleva irradiar la pared torácica reconstruida. Actualmente no se dispone de evidencia tipo I sobre cuál es la mejor reconstrucción, secuencia o tiempo asumible entre un procedimiento y otro cuando se realiza de forma diferente, por lo que continúa siendo un manejo institución-dependiente. Objetivos: Determinar la posible relación entre la aparición de complicaciones con y sin RTPM tras la RPM, en cuanto a: 1) morbilidad específica; 2) tasa de recurrencia del cáncer de mama; 3) morbilidad en función del momento de la RPM (inmediata vs diferida); 4) morbilidad en función de la técnica de reconstrucción (autóloga vs heteróloga) y 5) tratamiento sistémico, hormonoterapia, volumen de la prótesis y volúmenes diana de radioterapia. Material y Métodos: Estudio clínico observacional, retrospectivo y unicéntrico, basado en el análisis de una base de datos de 273 pacientes diagnosticadas de carcinoma de mama tratado mediante mastectomía y reconstrucción exclusiva o con radioterapia adyuvante asociada, entre los años 2016 y 2020, en el Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, y con un periodo de seguimiento mínimo de dos años. Se realizó el estudio descriptivo y comparativo entre los grupos con y sin RTPM respecto a una serie de variables (demográficas, anatomopatológicas, de tratamiento y de seguimiento), se ha procedido al análisis estadístico. Resultados: Tras una mediana de seguimiento de 65 meses, el 42,1% de los casos presentaron algún tipo de morbilidad asociada, sin diferencias entre las que recibieron RTPM y las que no (62,6% vs 37,4%, p=0,146). Dentro de las complicaciones, 55,7% se reconstruyeron mediante RPM inmediata, 23,5% diferida y 20,9% inmediato-diferida (p=0,027). Respecto a las complicaciones según técnica, en 27% se hicieron RPM autólogas y en 73% heterólogas (p<0,001). 59,6% recayeron a distintos niveles, objetivándose tendencia a la significación estadística a favor de la RTPM (p=0,063). La mediana de supervivencia fue de 44,50 meses y 35 meses (RTPM y no RTPM, respectivamente, p=0,809). No se encontró correlación entre la incidencia de complicaciones y la RTPM según administración de quimioterapia, hormonoterapia o adición de volúmenes ganglionares axilo-supraclaviculares, aunque sí con volúmenes protésicos iguales o superiores a 300cc (p=0,057). Conclusiones: No se ha encontrado correlación específica entre la administración de RTPM y las complicaciones tras la RPM. Sin embargo, se ha observado un aumento significativo de las mismas en las reconstrucciones heterólogas y en las realizadas de forma inmediata. También se ha observado una peor evolución cuando los volúmenes protésicos son superiores a 300cc, aunque no cuando los volúmenes de radioterapia incluyen las áreas ganglionares, además del lecho de mastectomía.