Severe Radiodermatitis and Implant Loss Associated with Pembrolizumab and Olaparib Following Pre-pectoral Breast Reconstruction in a 31-Year-Old Female: A Case Report

In young patients, there is a growing emphasis on both oncologic cure and aesthetic quality of life,. Accordingly, endoscopic nipple-sparing mastectomy with immediate implant reconstruction is increasingly adopted to preserve breast appearance and quality of life. Immune checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase (PARP) inhibitors have substantially improved survival in BRCA-mutated TNBC. However, the safety of sequential olaparib following concurrent pembrolizumab and radiotherapy in patients with pre-pectoral breast reconstruction remains poorly defined, and the risk of severe cutaneous toxicity and implant loss is underrecognized. This complex therapeutic combination presents a critical challenge to reconstructive safety and patient outcomes.