Differences in breast aesthetic outcomes due to radiation: A validated, quantitative analysis of expander-implant reconstruction

Abstract

Background The potential ramifications of radiation use can be of particular concern in the breast reconstruction population, in which both surgical and aesthetic outcomes are important. Presently, there remains a paucity of data detailing the influence of radiation on specific reconstruction aesthetic outcomes. Objective To conduct a quantitative evaluation of aesthetic outcomes for expander-implant breast reconstruction in radiated and nonradiated patients using a validated scoring scale. Methods A series of consecutive expander-implant breast reconstruction operations performed by the senior author between 2004 and 2012 were reviewed. Four blinded members of the Division of Plastic and Reconstructive Surgery at Northwestern University (Illinois, USA) independently rated postoperative photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains. Results Of the 206 patients meeting the inclusion criteria, 69 received radiotherapy and 137 did not. The radiated cohort had lower scores in each aesthetic domain, with significant differences in contour (1.33 versus 1.51; P=0.041) and placement (1.45 versus 1.73; P<0.001). Linear regression analysis revealed a significant association between placement scores and radiation, and radiated patients had a significantly higher overall rate of complications. Discussion Variances in scores may represent the relative difficulty of expansions and proper implant placement in irradiated tissue, with possible skin fibrosis and decreased flexibility hindering prosthesis manipulation. Conclusion Radiation adversely impacts breast contour and placement, with possible negative contributions to volume, scarring and inframammary fold definition, and results in higher rates of complications. Such detailed evaluation of the impact of radiation on aesthetics will enhance the management of patient expectations.

Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy

“…To understand the impact of surgical modality independently, we controlled for radiation and found that it decreased AS for NSM patients more significantly than for L patients. This aligns with published data on the consequences of radiation on breast reconstruction, [35][36][37][38] and led to the statistically significant difference between L and NSM.…”

Patient-Reported Satisfaction Following Radiation of Implant-Based Breast Reconstruction

“…This correlates with literature presenting expert opinion on the aesthetic results of IBR in the setting of adjuvant radiation therapy. 29 Our findings are consistent with that of 100 women who received PMRT in the setting of an implant reconstruction and scored lower on “satisfaction with breasts” on the BREAST-Q lower than nonradiated peers. 30 Our PMRT cohort also had more unilateral reconstructions (44% vs 77%) than the control group making symmetry and bra fitting challenging irrespective of receipt of PMRT, which could bias the results in favour of better breast appearance scores in the control group.…”

Breast reconstruction patterns and outcomes in academic and community practices within a single institution

“…Notable differences between the two cohorts included the increased prevalence of diabetes in the academic cohort at 11.2%, which is significantly higher than published rates for this population in the literature (4.9% to 5.7%) . A higher proportion of patients in the academic cohort had higher ASA classes than the community cohort.…”

“…The results confirm that breast reconstruction can be performed with comparable outcomes in both academic and community‐based plastic surgery practices. The autologous flap failure rate was below national reported averages for both groups and the rate of unexpected return to the operating room equivalent to national averages . Although outcomes were comparable, plastic surgeons performing breast reconstruction in the academic setting treated patients with significantly more perioperative medical, surgical, and psychological comorbidities.…”