Implant-based immediate breast reconstruction: failure rate when radiating the tissue expander or the permanent implant—a meta-analysis

Abstract

Background: Implant-based immediate approach remains to be a first line option for reconstruction of mastectomy defects. When combined with post-mastectomy radiation therapy (PMRT) two different schemas are possible: radiating the temporary tissue expander (TTE) or the permanent implant (PI). The present article intends to be the biggest cohort meta-analysis to the date comparing reconstructive failure (RF) rate in these two scenarios: PMRT to TE compared with PMRT to PI.Methods: A systematic search of the literature was performed on PUBMED/MEDLINE. The following key words were chosen: Breast Reconstruction AND Implant based AND Immediate. The time limit applied was from January 2008 to January 2019. We selected ten articles (n=1,130) to perform a meta-analysis due to the similarity of their approaches. Secondly, we did a simple literature review in order to identify some variables possibly working as predicting factors for RF.Results: Previous meta-analysis are analysed. Some variables possibly working as risk factors for RF are summarized. We performed a meta-analysis in two scenarios: a fixed-effect model and a random effect model.For the random effect model an OR of 1.85 was obtained (0.96, 3.57; P=0.067). A funnel plot is performed showing no publication bias exists.Conclusions: There is a tendency towards a higher RF rate when the TTE is irradiated compared with the irradiation of the PI. Further studies trying to elucidate the influence of the suggested risk factors for RF have to be performed to stablish a consensus about the indications and contraindications of this reconstructive modality.

Optimal Timing of Expander-to-Implant Exchange after Irradiation in Immediate Two-Stage Breast Reconstruction

“…Body mass index and size of tissue expanders increased the odds of 2-year complications. These findings were partially in line with the results of a recent meta-analysis, 31 which revealed that early exchange less than 3 months, 32 size of permanent implant, 3 advanced stage requiring chemotherapy, 32 and use of chest wall radiotherapy boosts were significant variables predicting reconstructive failure after postmastectomy radiation therapy. 33 The review revealed other potential risk factors, such as smoking status, 10 age older than 55 years, 34,35 low or high body mass index, 1,32 body weight, diabetes, nipple-sparing mastectomies, inframammary fold approach, and partial coverage of expanders or permanent implants.…”

Risk factors for severe complications and salvage management in direct-to-implant immediate breast reconstruction: A retrospective study

“…Immediate breast reconstruction has shown satisfactory aesthetic results and overall psychological well-being compared with delayed breast reconstruction. [ 4 ] Moreover, previous studies support the oncological safety of immediate breast reconstruction following total mastectomy. [ 5 , 6 ] Similar to the United States, implant-based breast reconstruction (IBR) is the most prevalent form of breast reconstruction in China, partly because of minimal donor site sacrifice and thus faster postoperative recovery, as well as a shorter learning curve, which is favored by more doctors and patients.…”

Patient-Reported Outcomes and Complication Profiles of Implant-Based Breast Reconstruction in Patients With Postmastectomy Radiation Therapy

“…Several published evidences had revealed contradictory findings regarding the cosmetic outcomes and complication rates with different types of IBBR surgery after PMRT. [14][15][16] Currently, with the increased delivery of PMRT along with an increased demand of IBBR in patients with stages II-III disease, oncologic and plastic surgeons need to recognize the distinct IBBR surgical methods in selected patients with PMRT. However, studies remain limited for identification of appropriate IBBR modality for patients administering PMRT, especially in China.…”

“…When PMRT is required, the ideal types of reconstructive surgery remain unclear. Several published evidences had revealed contradictory findings regarding the cosmetic outcomes and complication rates with different types of IBBR surgery after PMRT 14–16 …”