Impact of Prior Radiation on Postoperative Complications following Elective Implant Exchange

The indications for postmastectomy radiation therapy continue to expand. Although radiation therapy is associated with higher rates of complications, many patients undergo implant-based breast reconstruction despite radiation and will eventually require elective exchange of their permanent implant. However, the risks of elective implant exchange in the previously irradiated patient remain unknown.

A single-institution retrospective review was conducted of patients who underwent 2-stage implant-based breast reconstruction followed by elective implant exchange between 2010 and 2024. Patients were stratified by history of radiation, and the primary outcome was the incidence of postoperative complications following elective implant exchange. Logistic regression evaluated the association between prior radiation and postoperative complications.

A total of 1369 patients were included, and 244 (18%) underwent radiation and elective implant exchange. The overall complication rate was 5.6%, with significantly higher rates of complications among irradiated patients (13% versus 3.9%; P < 0.001). The incidence of infection (11% versus 2%; P < 0.001), reconstructive failure (4.9% versus 0.2%; P < 0.001), and prosthetic exposure (4.5% versus 0.2%; P < 0.001) was higher in irradiated versus nonirradiated patients. Radiation was independently associated with higher odds of any postoperative complication (OR, 3.51; 95% CI, 2.15 to 5.68; P < 0.001) and infection (OR, 6.19; 95% CI, 3.45 to 11.2; P < 0.001).

Patients with prior radiation therapy who undergo elective implant exchange experience significantly higher complication rates; however, the rate of reconstructive failure is 5%. These findings support elective implant exchange as a viable option in appropriately selected patients and underscore the importance of careful patient selection and thorough preoperative counseling to optimize outcomes in this high-risk population.