The postirradiated breast.

High-energy irradiation is used increasingly as a part of breast conservation treatment of malignant disease. The response of the breast tissue encompassed by the treatment fields varies considerably, even in well-conducted therapeutic programs. Early and late changes in the tissues include redness, edema, pigmentation, fibrosis, and retraction. Fibrosis and retraction may cause suboptimal cosmetic results and occur most frequently in obese patients, large breasts, and breasts from which a large (greater than 4 cm) primary tumor has been excised. Combinations of treatment modalities, such as adjuvant chemotherapy, surgical excision, and irradiation, seem to produce fewer excellent cosmetic results than single-modality treatment. In patients who have undergone breast conservation treatment, careful follow-up is necessary for detection of possible local, regional, or distant recurrence of the malignant disease, as well as of other diseases related or unrelated to the earlier treatment.