Radiation Therapy after Immediate Breast Reconstruction with Implants

Abstract

The use of implants in immediate breast reconstruction is presently a common option. However, the practice should be evaluated in consideration of possible adjuvant therapies needed to control disease and to rule out negative interactions. This article discusses the effects of radiotherapy on breast implants with regard to the final cosmetic result. Six out of 124 cases of immediate breast reconstruction with implants were followed and evaluated in terms of capsular contracture and final aesthetic result after adjuvant radiotherapy and compared with the results of 118 patients who did not require irradiation. All of the patients who received irradiation demonstrated poor to fair results, with grade III to IV capsular contracture. Two patients received radiation therapy for local recurrences, which worsened their capsular contracture, emphasizing the deleterious effect of irradiation on breast implants. Statistical analysis of the results demonstrated a significant difference between the two groups in terms of capsular contracture and breast symmetry. In the selection of patient candidates for immediate breast reconstruction with implants, adjuvant radiation therapy must be considered as a contraindication, at least from an aesthetic point of view.

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

“…Radiotherapy inevitably damages the tissue, and, as long as the modus of radiotherapy is unchanged, post-radiation breast reconstruction will be more challenging. Most studies find that radiotherapy in an implant-based reconstruction increases complications and late failure rates (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The results of the present study are in line with those of other studies in this field (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)30,31,33).…”

“…In the majority of studies, radiotherapy is shown to adversely affect outcome after implant-based breast reconstructions, with increased late failure rates (5,11,12), poor aesthetic results, loss of symmetry (13)(14)(15), capsular contracture, and infection, even when using the latest generation of implants (5,11,12,14,(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Nipple-Sparing Mastectomy with Primary Implant Reconstruction: Surgical and Oncological Outcome of 435 Breast Cancer Patients

“…Techniques have evolved since that time and today comprise the use of prosthetic materials, autologous tissue, or a combination thereof [12]. The cosmetic outcome of reconstruction with implant after postoperative radiotherapy is not always satisfactory because of capsular contracture and skin changes due to irradiation [13]. For that reason, Petit et al [14] suggested the concept of NSM followed by intraoperative radiotherapy and immediate reconstruction.…”

Breast reconstruction with alloplastic implants

“…These complications include pain, infection, implant rupture, wound dehiscence or implant exposure, implant migration, contractures, and, occasionally, a need for implant removal [1,8,9,38,42,47,[50][51][52]. Also, the rate of patients satisfaction with cosmetic outcome ranged widely from 7% to 88%, as compared to 64% to 97% in non-irradiated patients [6,8,40,[44][45][46][47][48]51,53]. The major primary cause of unfavorable cosmetic results in these cases is capsular contracture [1,9,38,42,43,52,54], which is possibly attributed to subclinical infections, hemorrhage, and radiation fibrosis [42,55].…”