Postmastectomy radiation therapy（PMRT）for breast reconstruction has led to concerns regarding associations with higher complication rates and reduced esthetic outcomes. In this multicenter cross-sectional study, patient-reported outcomes were analyzed to investigate the impact of PMRT on safety and health-related quality of life（HR-QOL）in patients undergoing breast reconstruction. A questionnaire survey was administered to patients diagnosed with primary breast cancer who underwent breast reconstruction between January 2008 and December 2022 at participating institutions. Complications and HR-QOL were compared between non-PMRT and PMRT groups. The overall complication rates were 50.1 and 77.9%, respectively. HR-QOL assessment using BREAST-Q demonstrated significantly lower scores in the PMRT group for breast satisfaction, chest physical well-being, and psychosocial well-being. This study indicated that PMRT is associated with a higher risk of complications and HR-QOL reduction among patients undergoing breast reconstruction. However, these findings do not negate the potential therapeutic benefits of PMRT; rather, they underscore the importance of providing patients with accurate information about the risks and effects of PMRT to promote shared decision-making with realistic expectations.

The health insurance system is the core system of medical care in Japan, with universal coverage. However, many members may not be aware of how certain medical technologies are covered and widely used. This article describes the path to insurance coverage and the organization that plays a central role （Gaihoren), and describes as vividly as possible the correspondence with the Ministry of Health, Labor and Welfare regarding fat grafting in the R6 revision, with the aim of deepening members’ understanding of the work of the insurance committees and the efforts to get fat grafting on the insurance list.