Skin perfusion and oxygen saturation after mastectomy and radiation therapy in breast cancer patients

• Published in: Breast (Edinburgh) Vol. 75; p. 103704
• Main Authors: Elawa, Sherif, Fredriksson, Ingemar, Steinvall, Ingrid, Zötterman, Johan, Farnebo, Simon, Tesselaar, Erik
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-06-2024; Elsevier
• Subjects: Adult; Aged; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Female; Humans; Laser-Doppler Flowmetry; Mastectomy; Microcirculation - radiation effects; Middle Aged; Oxygen Saturation - radiation effects; Radiotherapy, Adjuvant - adverse effects; Skin - blood supply; Skin - radiation effects; Thoracic Wall - radiation effects; Vasodilator Agents - administration & dosage
• ISSN: 0960-9776; 1532-3080; 1532-3080
• DOI: 10.1016/j.breast.2024.103704

The pathophysiological mechanism behind complications associated with postmastectomy radiotherapy (PMRT) and subsequent implant-based breast reconstruction are not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion and saturation in the skin after mastectomy and assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate – MN).
Skin microvascular perfusion and oxygenation >2 years after PMRT were measured using white light diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LDF) in the irradiated chest wall of 31 women with the contralateral breast as a control. In the non-irradiated breast, the perfusion after application of MN (median 0.84, 25th–75th centile 0.59–1.02 % RBC × mm/s) was higher compared to the irradiated chest wall (median 0.51, 25th–75th centile 0.21–0.68 % RBC × mm/s, p < 0.001). The same phenomenon was noted for saturation (median 91 %, 25th–75th centile 89–94 % compared to 89 % 25th–75th centile 77–93 %, p = 0.001). Eight of the women (26%) had a ≥10 % difference in skin oxygenation between the non-irradiated breast and the irradiated chest wall.
These results indicate that late microvascular changes caused by radiotherapy of the chest wall significantly affect skin perfusion and oxygenation.
•Skin perfusion and oxygenation in the breast are affected several years after radiotherapy.•Complications following reconstructive surgery after PMRT may, at least partly, be explained by changes in microvascular blood flow or microvascular responsiveness.•MN provocation followed by white light diffuse reflectance spectroscopy (DRS) combined with Laser Doppler Flowmetry (LDF) may be a valuable clinical tool prior to deciding surgical procedures after PMRT.