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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Two-Stage Prosthetic Breast Reconstruction after Mastectomy with or without Prior Postmastectomy Radiotherapy.

Thomas C Lam1, Frank Hsieh1, James Salinas1

  • 1Department of Plastic and Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia; and Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.

Plastic and Reconstructive Surgery. Global Open
|October 25, 2017
PubMed
Summary
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Delayed two-stage breast reconstruction using prosthetics is effective, even after radiation therapy. Smoking increases the risk of implant loss in these patients, necessitating careful consideration.

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Area of Science:

  • Plastic Surgery
  • Oncology
  • Reconstructive Surgery

Background:

  • Two-stage prosthetic breast reconstruction is a common procedure.
  • Limited data exists on delayed reconstruction, particularly after postmastectomy radiotherapy (RT).
  • This study reviews outcomes of delayed prosthetic breast reconstruction over 12.5 years.

Purpose of the Study:

  • To evaluate the success and complication rates of delayed two-stage prosthetic breast reconstruction.
  • To compare outcomes between patients who received postmastectomy radiotherapy (RT) and those who did not.
  • To assess the impact of smoking on reconstruction outcomes.

Main Methods:

  • Retrospective review of 170 patients undergoing delayed two-stage prosthetic breast reconstruction.
  • Patients divided into two groups: no postmastectomy RT (Group A, n=150) and postmastectomy RT (Group B, n=20).
  • Primary outcome was prosthesis loss; secondary outcomes included other complications and revisional surgery rates.

Main Results:

  • Overall prosthesis loss rate was low.
  • Group B (postmastectomy RT) had a significantly higher rate of prosthesis loss (15%) compared to Group A (2.0%; P=0.02).
  • Smoking was a significant risk factor for prosthesis loss in both groups (P<0.01).

Conclusions:

  • Delayed two-stage prosthetic breast reconstruction demonstrates a low failure rate.
  • Successful reconstruction is achievable in selected patients post-radiotherapy.
  • Smoking cessation counseling is crucial for patients undergoing this procedure, especially those with prior RT.