Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: An argument about timing

Javaid, M K; Song, Feng; Leinster, SJ; Mg, Dickson; James, NK

doi:10.1016/j.bjps.2005.07.007

Cited by 65 publications

(46 citation statements)

References 17 publications

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“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications of the flaps after autologous reconstruction (25), although not all studies agree on this (26,27). However, autologous breast reconstruction provides reduced morbidity than implantbased reconstruction in the setting of postoperative radiotherapy (2,26).…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications after autologous reconstruction (25); however, not all studies are in agreement (26,27). Certain studies show that postoperative radiotherapy to the breast reconstructed with a deep inferior epigastric perforator flap (DIEP) or transverse rectus abdominis myocutaneous (TRAM) flap has no effect on the reconstruction (28,29), while several others show a considerable negative effect on the final results of autologous reconstruction (24,26,(30)(31)(32)(33)(34).…”

Section: The Effect Of Radiotherapy On Breast Reconstructionmentioning

confidence: 99%

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Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: The Effect Of Radiotherapy On Breast Reconstructionmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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“…Consequently, as postoperative complications exacerbated by radiation are discussed, similar statements cannot yet be made regarding radiation and aesthetic outcomes. Other studies have also attempted to quantify overall aesthetics in the setting of radiation, but were limited by small patient populations, nonvalidated scoring scales and/or possible evaluator bias (13)(14)(15)(16).…”

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confidence: 99%

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

Mioton

Gaido

Small

et al. 2013

Canadian Journal of Plastic Surgery

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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.

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“…Whether the timing of radiotherapy delivery before or after implant reconstruction influences the complication rate has been investigated by Javaid et al (2006) who performed a systematic review of published studies including at least 20 patients. There were no randomized trials on the topic identified.…”

Section: Sequencing Of Reconstruction and Radiotherapymentioning

confidence: 99%

Consequences of Radiotherapy for Breast Reconstruction

Russell¹,

Scharpfenecker²,

Hoving³

et al. 2012

Selected Topics in Plastic Reconstructive Surgery

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Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: An argument about timing

Cited by 65 publications

References 17 publications

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

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

Consequences of Radiotherapy for Breast Reconstruction

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