Single Stage Direct-to-Implant Breast Reconstruction Has Lower Complication Rates Than Tissue Expander and Implant and Comparable Rates to Autologous Reconstruction in Patients Receiving Postmastectomy Radiation

Radiotherapy Increases Major Complications and Complication-related Reconstruction Failures in Patients with Implant-based Breast Reconstruction

“…The approach of integrating PMRT with breast reconstruction, including the selection of different reconstruction types in the setting of PMRT, the relative sequence of PMRT and breast reconstruction and the optimization of radiotherapy techniques, has been studied widely and remains controversial [6, [12][13][14][15].…”

A multidisciplinary view of mastectomy and breast reconstruction: Understanding the challenges

“…In this, factors such as the type and timing of reconstruction must be considered, taking into account also a possible indication for PMRT. The patient needs to be informed that PMRT can be associated with increased severity and rates of complications, including impaired aesthetic outcomes, all of which are highly related to the type of reconstruction [52,53]. The best timing of PMRT in the setting of any method of reconstruction is controversial [35,53,54].…”

“…The patient needs to be informed that PMRT can be associated with increased severity and rates of complications, including impaired aesthetic outcomes, all of which are highly related to the type of reconstruction [52,53]. The best timing of PMRT in the setting of any method of reconstruction is controversial [35,53,54]. Moreover, the need for PMRT often cannot be determined until the final pathologic evaluation is complete, thereby after surgery, unless a sentinel node biopsy or axillary dissection is performed prior to the breast surgery.…”

“…Breast reconstruction following mastectomy can be performed using various techniques, including positioning a tissue expander that is replaced by a permanent implant in a second procedure before or after PMRT [55] (2-stage procedure with expander and implant, TE/I). Breast reconstruction can be performed by one stage implant-based reconstruction (single-stage direct-to-implant, DTI), autologous tissue breast reconstruction (ABR), or a combination of expander/implant and autologous tissue [53,55]. The type of reconstruction depends on patient-related factors, such as BMI, smoking, body habitus (i.e., breasts size and shape, excess skin quality, need for reduction/mastopexy of the contralateral breast, donor sites (like amount of fat in the abdominal area and/or thighs), comorbidity and surgeon's expertise with any given technique.…”

Complications May Outweigh the Benefits

“…Additionally, patients with medial nodenegative tumors were eligible for European Organisation for Research and Treatment of Cancer trial 22922/ 10925, which demonstrated a breast cancer recurrence benefit at 15 years with regional nodal irradiation. 4 Therefore, radiation fields would include the left chest wall and the internal mammary, supraclavicular, and undissected axillary lymphatic regions. Treatment would be given using tangential fields with deep inspiratory breath hold to a dose of 50 Gy in 2 Gy per fraction.…”