Severe skin reactions are commonly observed after breast irradiation. Chronic ulcerations, soft tissue damage and osteonecrosis are well-known though relatively rare long-term radiation-induced injuries. The ever-present possibility of recurrence or persistence of the primary malignant neoplasm within the irradiated tissue must be always suspected and adequately established by multiple biopsies before planning an eventual resective and or reconstructive strategy. In the present report a neoplastic recurrence arised from an extensive radiation-induced ulceration along the parasternal area with chest wall osteonecrosis complicated by infection in a 42 y.o. woman, who had received postoperative roentgen therapy a long time before for breast carcinoma and thyroid cancer, is described. Radiation-induced injuries and therapeutical options are discussed in relation to the site of the lesion and to the complexity of the single case. In conclusion, when recurrent malignancy is present, although the long-term prognosis may be poor, the quality of life of many patients undoubtedly may be improved by a multidisciplinary approach involving oncologysts, as well as general, thoracic and plastic surgeons.