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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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Limiting complication rates in implant-based breast reconstruction
Michelle B Locke1, William LE Malins2, Jia Le See3
1University of Auckland School of Medicine, Auckland; Department of Plastic and Reconstructive Surgery, Counties Manukau District Health Board, Auckland.
The New Zealand Medical Journal
|February 23, 2018
Summary
External beam radiotherapy (XRT) increases complications and failure in implant-based breast reconstruction (IBBR). Shifting to autologous reconstruction for patients needing XRT reduced these adverse outcomes, improving success rates.
Area of Science:
- Oncology
- Plastic Surgery
- Radiotherapy
Background:
- External beam radiotherapy (XRT) is linked to higher complication rates in implant-based breast reconstruction (IBBR).
- Concerns over high complication and failure rates led to a policy shift favoring autologous reconstruction for patients requiring XRT in 2013.
Purpose of the Study:
- To assess the outcomes of implant-based breast reconstruction (IBBR) before and after a policy change favoring autologous reconstruction for patients requiring external beam radiotherapy (XRT).
Main Methods:
- A retrospective review of first-stage IBBR procedures performed in 2012 and 2013.
- Identification of patients undergoing peri-operative XRT.
- Analysis of complication and reconstructive failure rates.
Main Results:
- External beam radiotherapy (XRT) was significantly associated with higher reconstructive failure rates.
- Pre-operative XRT was linked to increased overall complications (p=0.0099).
- Complications decreased from 43.2% to 27.5%, and reconstructive failure fell from 16.2% to 10% over the study period.
Conclusions:
- Peri-operative XRT significantly increases complication rates and reconstructive failure in IBBR.
- The current policy of recommending autologous reconstruction for patients with pre-operative XRT appears to reduce complications and improve reconstructive success.
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