We describe two cases of cellulitis occurring around ink sites, following tattooing for adjuvant radiotherapy in two patients who had undergone latissimus dorsi-with-implant breast reconstructions. One patient was successfully treated with intravenous antibiotics. The second patient developed a peri-implant infection requiring implant removal. Patients with implant-based breast reconstructions should be warned of the potential infection risk of radiotherapy tattooing.

Radiation therapy is an important part of the modern multimodality treatment of breast cancer, and in the past decade has had an increasing role in the treatment of patients at intermediate to high risk for local-regional recurrence after mastectomy. During the same time period, a less radical surgical approach to mastectomy has developed that is more compatible with reconstruction, and a greater number of young patients diagnosed due to screening who are more motivated and candidates for the procedure. This has led to an increased need to consider the special implications of combining radiation with breast reconstruction. This review will focus on reconstruction by tissue expander and breast implants. A multidisciplinary approach to management is needed that includes a team of a plastic surgeon, and radiation, surgical and medical oncologists. Experience with implant reconstruction and radiation in the past decade has been associated with relatively high rates of complications and/or implant loss compared with unirradiated patients. However, newer techniques of radiation, and improved patient selection and coordination between the multidisciplinary team offer the promise of low complication rates and good or excellent cosmetic results for most patients in the future.