Radiotherapy Effect on Immediate Two-Stage Post Mastectomy Breast Reconstruction

Abstract

Background and aims. In the field of breast reconstruction, the two-stage tissue expander/implant technique is commonly used. However, radiation therapy, which is often employed in implant-based reconstruction, has well-documented negative effects such as increased risk of implant exposure, infection, capsular contracture, and other surgical complications. This study aimed to compare the outcomes of patients who underwent radiation therapy prior to implant exchange with a control group of non-irradiated patients, focusing on complications, capsular contracture, revision surgery, and the use of autologous salvage. Methods. This study included 30 patients who underwent immediate two-stage tissue expander/implant reconstruction. They were divided into two groups: irradiated group of 11 patients and control group of 19 patients. Numerous factors such as complications, capsular contracture, revision surgery, and autologous salvage rates were examined and compared between the two groups. We standardize other factors such as patient age, chronic illness for both groups. Results. The irradiated group showed 4.2 times higher of major complications compared to the control group (p = 0.001). The rate of grade III and IV capsular contracture was significantly higher in the irradiated group (21.7%) compared to the control group (10%; p < 0.008). Conclusions. This study concludes that irradiation of the tissue expander after mastectomy is associated with a higher risk of complications. After reviewing another studies, the capsular contracture rate in these patients -which considered the most major complication- with this approach is still acceptable compared to other implant-based radiotherapy approaches. Based on these findings, immediate tissue expander/implant reconstruction can be considered a viable surgical option for patients undergoing post mastectomy radiation therapy.