Long-term outcomes of implant-based immediate breast reconstruction with and without radiotherapy: a population-based study

Abstract

Background Radiotherapy (RT) is a risk factor for impaired outcomes after implant-based immediate breast reconstruction (IBR). Large studies including long-term follow-up are relatively scarce. The purpose of this analysis was to assess long-term effects of RT in implant-based IBR, distinguishing between implant removal because of postoperative complications versus patient preference. Methods This population-based cohort study included all patients with breast cancer who underwent implant-based IBR in Stockholm between 2005 and 2015. Data were collected through national registers and medical charts. The main endpoint was implant removal owing to postoperative complications (wound breakdown, infection, bleeding) or patient preference (dissatisfaction, pain, capsular contracture), with or without conversion to autologous reconstruction. Results Some 1749 implant-based IBRs in 1687 women were included. Median follow-up was 72 (range 1–198) months. Reconstructions were divided according to receipt of RT: No RT (n = 856, 48.9 per cent), adjuvant RT (n = 749, 42.8 per cent), and previous RT (n = 144, 8.2 per cent). Implant removal occurred after 266 reconstructions (15.2 per cent); 68 (7.9 per cent) in the no RT, 158 (21.1 per cent) in the adjuvant RT, and 40 (27.8 per cent) in the previous RT group. Implant removal was because of postoperative complications in 152 instances (57.1 per cent) and was most common in the first 3 years. This was especially observed in the previous RT group, where 15 of 23 implant removals occurred during the first 6 months. Implant removal owing to patient preference (114 of 266, 42.9 per cent) became more common with increasing follow-up. Conclusion Implant removal after implant-based IBR is significantly associated with RT. The reason for implant removal shifts over time from postoperative complications to patient preference.

Immediate Breast Reconstruction With Latissimus Dorsi Myocutaneous Flap and Silicone Implant Followed by Adjuvant Radiotherapy for Breast Cancer

“…Incidence rates of capsular contracture and unplanned reoperations, resulting in late breast reconstruction failure, increase with exposure to ART. 5,15 However, IBR, even when ART is indicated, improves the quality of life of women undergoing mastectomy, preventing temporary loss of the breast. 7,9 Thus, the use of the IBR technique should be judicious and individualized.…”

“…Patients who received ART were more than 2 times more likely to experience IBR failure (HR, 2.44; 95% CI, 1.70-3.52; P < 0.001). 5 A retrospective study has the advantage of being less expensive to perform and can be accomplished within a much shorter time frame compared with a prospective study. However, it is more subject to biases and limitations regarding the selection of an adequate sample.…”

“…According to the literature, reoperations and signs and symptoms of capsular contracture usually occur 1 year after IBR. 5,28,29 The present study used real-life data to evaluate the outcomes of a surgical technique widely used in clinical practice, especially in settings without microsurgical expertise, but with lack of information in the medical literature. Our results may improve the understanding of IBR with LDM flap and silicone implant, thus contributing to the surgical management and enhancement of quality of life of women with breast cancer.…”

“…4 Although radical surgeries have decreased worldwide, about 30% to 50% of women with breast cancer will undergo mastectomy, and approximately 50% of these patients will receive adjuvant radiotherapy (ART). 4,5 Breast reconstruction after mastectomy is important in the rehabilitation of patients, as it provides physical and psychological benefits. 6,7 There is a growing interest in improving the quality of life of women treated for breast cancer, and immediate breast reconstruction (IBR) plays an important role in this process.…”

“…8,9 Faced with advances in treatment and survival in breast cancer, the multidisciplinary team should prioritize breast reconstruction using safe approaches that yield long-lasting aesthetic outcomes, especially in the ART setting. 5 Studies on different IBR techniques reporting medium-and long-term oncological outcomes are scarce, with great emphasis being placed on IBR with tissue expander or direct-toimplant reconstructions. 10 Immediate breast reconstruction using the direct-to-implant technique has been reported to result in up to 40% breast reconstruction failure when combined with ART, depending on the follow-up duration of the study.…”