Influence of Radiotherapy on Immediate Breast Reconstruction After Skin-sparing Mastectomy. Before or After: Does It Matter?

Cabañuz, Marta Allué; Amo, María Dolores Arribas del; Barles, Ana Navarro; Sánchez, Angel Martı́nez

doi:10.1016/j.cireng.2019.02.009

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…In the available literature, it has been demonstrated that adjuvant radiotherapy increases the number of surgical complications two-to three-fold. [30][31][32] The significant differences in relative SST between the skin adjacent to the scar and the scar itself (delta 1) and between the other breast and scar (delta 2) of ciNPWT were only demonstrated at V1-the first follow-up visit after dressing removal. The adhesive dressing in ciNPWT had a size of 8 × 13 cm, so the physical effects of negative pressure could extend to the surrounding areas, including the point of measurement.…”

Section: Discussionmentioning

confidence: 99%

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“A Prospective, Randomized Study Comparing Closed Incision Negative Pressure Wound Therapy with Standard Care in Immediate Postmastectomy Breast Reconstruction.”

Pieszko

Wichtowski

et al. 2022

Plastic &Amp; Reconstructive Surgery

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he rate of breast cancer has recently been increasing by 0.5% annually. 1 Rapid diagnosis and efficacy of neoadjuvant and adjuvant therapies have permitted an increase in Background: Breast cancer remains the most common nonskin cancer among women. Prophylactic methods for reducing surgical-site complications after immediate breast reconstruction (IBR) are crucial to prevent acellular dermal matrices or prosthesis exposure and loss. The authors assessed the impact of closed-incision negative-pressure wound therapy (ciNPWT) versus standard dressings (ST) after IBR on surgical-site complications, superficial skin temperature (SST), skin elasticity, and subjective scar quality, to determine the potential benefit of prophylactic ciNPWT application. Methods: A multicenter randomized controlled study of 60 adult female patients was conducted between January of 2019 and July of 2021. All patients had oncologic indications for IBR using implants or expanders. Results: Application of ciNPWT correlated with a significant decrease in surgical-site complications within 1 year of surgery (total, 40%; ST, 60%; ciN-PWT, 20%; P = 0.003) and resulted in more elastic scar tissue as measured with a Cutometer (average coefficient of elasticity, 0.74; ST, 0.7; ciNPWT, 0.9; P < 0.001). The SST of each scar 1 week after surgery was significantly higher in the ciNPWT group (average SST, 31.5; ST SST, 31.2; ciNPWT SST, 32.3; P = 0.006). According to the Patient and Observer Scar Assessment Scale v2.0, subjective scar outcomes in both groups were comparable. Conclusions: This is the first randomized controlled study that demonstrated a significant decrease in surgical-site wound complications within 1 year of surgery in IBR patients receiving ciNPWT. A high probability of postoperative radiotherapy should be a relative indication for the use of ciNPWT.

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Section: Discussionmentioning

confidence: 99%

“…In the available literature, it has been demonstrated that adjuvant radiotherapy increases the number of surgical complications two- to three-fold. 30–32…”

Section: Discussionmentioning

confidence: 99%

“A Prospective, Randomized Study Comparing Closed Incision Negative Pressure Wound Therapy with Standard Care in Immediate Postmastectomy Breast Reconstruction.”

Pieszko

Wichtowski

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Other considered factors are the complications that lead to the need for excision and loss of the prosthesis 14 . Given this scenario, scientists have questioned whether RT after reconstruction would be the ideal approach, but a study presented by Allué et al in 2019 showed that RT before reconstruction brought higher risks of failure when compared with patients who received the postreconstruction treatment 29 .…”

Section: Discussionmentioning

confidence: 99%

Influence of the breast prosthesis volume in dose distribution in radiotherapy planning

et al. 2021

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Introduction: The challenge of modern radiotherapy (RT) in breast cancer is to maintain its satisfactory oncological results, adapting to oncoplastic surgery and avoiding possible cosmetic damage. Considering that the breast prosthesis is not a target volume in RT planning, this study sought to analyze the effect of this volume on the coverage of the clinical target volume (CTV) of the breast. Methods: We performed a retrospective analysis of plans in 48 patients who submitted to RT in the first half of 2014. Two volumes were measured, such as breast CTV (breast tissue with the prosthesis) and real CTV (breast tissue excluding the prosthesis). The D95% values (dose that covers 95% of the volume) for each of them were verified and related to the volume of each one as well as the volume of breast prosthesis. Results: The analysis of the CTVs showed a significant difference between the mean volumes for the real CTV and breast CTV. While performing the CTV coverage, including the prosthesis, there is a perception that the dose covered 95% of the volume. Nevertheless, the analysis of the same plan after prosthesis volume exclusion revealed a difficulty in covering 95% of the breast tissue volume, indicating the interference of the prosthesis in therapy planning. Considering the dosimetric aspects, there were patients with real CTV values below the ideal dose of 47.5 Gy, after exclusion of implant volume. Conclusions: Our data reflected the volume of the prosthesis as an important variable that should be considered when planning adjuvant RT.

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“…Radiotherapy was the most important risk factor for developing surgical-site complications, as previously reported in the literature. 2 There is some heterogenicity between the cohorts that is not represented by sufficient statistical significance but raises questions and may be a potential source of bias. In direct conjunction with the above-mentioned factors, the small sample size in this study may potentially compromise the validity of the conclusions that can be drawn and makes it prone to bias.…”

mentioning

confidence: 99%

“…Radiotherapy was the most important risk factor for developing surgical-site complications, as previously reported in the literature. 2…”

mentioning

confidence: 99%

Discussion: A Randomized Study Comparing Closed-Incision Negative-Pressure Wound Therapy with Standard Care in Immediate Breast Reconstruction

Pánková

Montorfano

2023

Plastic &Amp; Reconstructive Surgery

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Influence of Radiotherapy on Immediate Breast Reconstruction After Skin-sparing Mastectomy. Before or After: Does It Matter?

Cited by 6 publications

References 14 publications

“A Prospective, Randomized Study Comparing Closed Incision Negative Pressure Wound Therapy with Standard Care in Immediate Postmastectomy Breast Reconstruction.”

“A Prospective, Randomized Study Comparing Closed Incision Negative Pressure Wound Therapy with Standard Care in Immediate Postmastectomy Breast Reconstruction.”

Influence of the breast prosthesis volume in dose distribution in radiotherapy planning

Discussion: A Randomized Study Comparing Closed-Incision Negative-Pressure Wound Therapy with Standard Care in Immediate Breast Reconstruction

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