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Postmastectomy Radiation Therapy on Permanent Implants or Tissue Expanders: Which is Better?
Alex M Lin1, Joani M Christensen1, Eric C Liao1
1Division of Plastic Surgery, Massachusetts General Hospital, Boston, MA.
Annals of Surgery
|November 13, 2019
Summary
Direct-to-implant breast reconstruction after radiotherapy shows fewer complications and failures than tissue expander-implant reconstruction. This finding aids in choosing optimal breast reconstruction methods post-mastectomy radiation.
Area of Science:
- Oncology
- Plastic Surgery
- Radiotherapy
Background:
- Postmastectomy radiotherapy can negatively impact breast reconstruction outcomes.
- The comparative effects of radiotherapy on direct-to-implant (DTI) versus tissue expander-implant (TEI) reconstruction are not well-established.
Purpose of the Study:
- To evaluate and compare complication and reconstructive failure rates in implant-based breast reconstruction following radiotherapy.
- To determine if DTI reconstruction is superior to TEI reconstruction in radiated patients.
Main Methods:
- Retrospective review of 1566 patients undergoing implant-based breast reconstruction.
- Analysis of 265 patients who received postmastectomy radiotherapy, comparing DTI (n=149) and TEI (n=116) groups.
- Follow-up duration of 2 to 10 years.
Main Results:
- Patients receiving radiotherapy with TEI experienced significantly higher rates of complications (32.8% vs 11.4%), skin necrosis (10.3% vs 4.0%), wound breakdown (9.5% vs 2.7%), and infections (16.4% vs 4.03%) compared to DTI.
- TEI reconstruction in radiated patients had a higher failure rate (21.6% vs 11.4%).
- Radiation boost was a predictor of complications (OR 2.199).
Conclusions:
- Implant-based breast reconstruction is generally successful following mastectomy and radiotherapy.
- Radiotherapy following DTI breast reconstruction is associated with lower complication and failure rates compared to TEI reconstruction.
