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Updated: Sep 1, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Post-mastectomy adjuvant radiotherapy for direct-to-implant and two-stage implant-based breast reconstruction: A
Fengzhou Du1, Runzhu Liu2, Hailin Zhang2
1Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China; State Key Laboratory of Complex Severe and Rare Diseases (Peking Union Medical College Hospital).
Background:
In recent years, immediate replacement with a prosthesis (direct-to-implant, DTI) is gaining more popularity than two-staged methods (tissue expander followed by an implant, TEI). The safety of immediate implant-based breast reconstruction (IBR) is debatable when postmastectomy radiotherapy (PMRT) is indicated. This meta-analysis aims to evaluate the outcomes of DTI and TEI procedures followed by PMRT.
Methods:
Studies searched in the PubMed/Embase/The Cochrane Library databases (1995-2021) were filtered by exclusion criteria. Cases were divided into PMRT and non-irradiated groups, PMRT with a permanent implant or tissue expander. The outcomes were capsular contracture and other complications.
Results:
A total of 22 studies with 6964 patients were included. PMRT increased the risk of capsular contracture in DTI patients and caused other complications in TEI patients. In PMRT and non-irradiated groups, the mean rates of capsular contracture were 17.01% versus 3.30% (p < 0.01) in IBR and 15.49% versus 5.70% (p < 0.01) in DTI. The mean rates of other complications were 22.59% versus 11.29% (p < 0.01) in IBR, 31.88% versus 27.87% (p = 0.35) in DTI, and 22.11% versus 9.90% (p < 0.01) in TEI. Implants and tissue expanders caused a similar rate of capsular contracture and other complications.
Conclusion:
PMRT is related to a higher risk of complication and capsular contracture in IBR, including DTI procedure. This negative effect may not be related to the type of breast contents during radiotherapy.
