Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions

Whitfield, Gillian A; Horan, Gail; Irwin, Michael S.; Malata, Charles M.; Wishart, Gordon; Wilson, Charles B.

doi:10.1016/j.radonc.2008.09.023

Cited by 124 publications

(73 citation statements)

References 22 publications

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“…Our research will allow TPS to accurately calculate dose distribution surrounding the metallic port. Without this information, clinicians may ignore the dose perturbation or prescribe an inaccurate amount of additional dose to compensate for the miscalculated dose shadow, which may either cause the loss of target coverage or increase the risk of complications like capsular contracture since radiation to the breast after reconstruction can significantly increase the rates of these complications 10, 30. The methodology utilized in this study can also be used to investigate other high‐density materials within the patient, e.g., metal implants within chordoma patients, pacemaker, hip prosthesis, dental implants, etc.…”

Section: Resultsmentioning

confidence: 99%

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Yoon

Xie

Heins

et al. 2018

J Applied Clin Med Phys

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The purpose of this study was to model the metallic port in breast tissue expanders and to improve the accuracy of dose calculations in a commercial photon treatment planning system (TPS). The density of the model was determined by comparing TPS calculations and ion chamber (IC) measurements. The model was further validated and compared with two widely used clinical models by using a simplified anthropomorphic phantom and thermoluminescent dosimeters (TLD) measurements. Dose perturbations and target coverage for a single postmastectomy radiotherapy (PMRT) patient were also evaluated. The dimensions of the metallic port model were determined to be 1.75 cm in diameter and 5 mm in thickness. The density of the port was adjusted to be 7.5 g/cm3 which minimized the differences between IC measurements and TPS calculations. Using the simplified anthropomorphic phantom, we found the TPS calculated point doses based on the new model were in agreement with TLD measurements within 5.0% and were more accurate than doses calculated based on the clinical models. Based on the photon treatment plans for a real patient, we found that the metallic port has a negligible dosimetric impact on chest wall, while the port introduced significant dose shadow in skin area. The current clinical port models either overestimate or underestimate the attenuation from the metallic port, and the dose perturbation depends on the plan and the model in a complex way. TPS calculations based on our model of the metallic port showed good agreement with measurements for all cases. This new model could improve the accuracy of dose calculations for PMRT patients who have temporary tissue expanders implanted during radiotherapy and could potentially reduce the risk of complications after the treatment.

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Section: Resultsmentioning

confidence: 99%

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Yoon

Xie

Heins

et al. 2018

J Applied Clin Med Phys

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“…Multiple studies and reviews showed that post-mastectomy radiation therapy is associated with a higher incidence of complications and implant loss (18)(19)(20)(21)(22). Furthermore, literature states that radiation therapy has a negative impact on cosmetic outcome, due to often severe Gland Surg 2017;6(1):43-48 gs.amegroups.com capsular contracture after implant-based reconstruction (21)(22)(23)(24)(25). As a result, reconstructed patients with radiation therapy had significantly lower satisfaction with outcome (21,26), psychosocial well-being, sexual well-being and physical well-being (26).…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

et al. 2017

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Background: Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR.Methods: Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy.Results: Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR.Conclusions: Anticipated radiation therapy, higher age and higher BMI were important breast surgeonrelated factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.Keywords: Breast neoplasms; breast reconstruction; decision making; mammaplasty; mastectomy Submitted Aug 11, 2016. Accepted for publication Oct 27, 2016Oct 27, . doi: 10.21037/gs.2016 View this article at: http://dx.doi.org/10.21037/gs.2016.11.11 44 Weenk et al. Decision-making process in IBR © Gland Surgery. All rights reserved.Gland Surg 2017;6(1):43-48 gs.amegroups.com States. In 2000, 12.9% of all mastectomies performed in the United States were combined IBR, increasing to 36.3% in 2009 (15). The United Kingdom Association of Breast Surgery recommends that any patient in which IBR is oncologically safe should have the possibility to choose for IBR (16). Dutch guidelines state IBR has a slight preference instead of delayed reconstruction and that every patient considered for mastectomy has to be informed about reconstructive options (17). However, despite the evidence and recommendations, almost two thirds of the mastectomies are still performed without IBR. We asked ourselves if there are elements in the pre-operative process that could facilitate or impede the choice for IBR. The major objective of this study was to investigate the decision-making process on whether or not a patient undergoes immediate reconstruction after mastectomy. In this study we focused on the role of patient as well as the role of the breast surgeon. MethodsWe investigated all electronic patient files of women diagnosed with DCIS or invasive carcinoma between 2010 and 2013, and underwent a mastectomy at the Canisius Wilhelmina Breast Center in Nijmegen, the Netherlands. Patients who underwent prophylactic mastectomy were excluded. IBR is defined as mastectomy and reconstruction performed on the same day. ...

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“…7 Although capsular contracture can occur in the absence of radiation in patients with implant reconstructions, radiotherapy is a known risk factor for increased capsular contracture rates. 19,21 The retrospective nature of our study limited the ability to distinguish between radiation-induced capsular contracture and other subjective reasons for PIRR that may impact the decision for implant replacement. Therefore, the category ''multifactorial'' was used also to describe etiologies for implant replacement other than capsular contracture, such as suboptimal cosmesis or patient or physician dissatisfaction, many of which are often interrelated.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Cordeiro

Disa

et al. 2011

Cancer

113

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BACKGROUND: Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated. METHODS: Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR. RESULTS: Median follow-up was 86 months (range, 11-161 months). The 7-year PIRRfree rate was 71% (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1% (21), and removal was 13.3% (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81% and overall survival 93%. CONCLUSIONS: Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population. Cancer 2012;118:2552-

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Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions

Cited by 124 publications

References 22 publications

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

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