The Effect of Radiation on Quality of Life throughout the Breast Reconstruction Process: A Prospective, Longitudinal Pilot Study of 200 Patients with Long-Term Follow-Up

Devulapalli, Chris; Bello, Ricardo J.; Moin, Emily E.; Alsobrooks, J.P.; Fallas, P; Ohkuma, Rika; Manahan, Michele A.; Sacks, Justin M.; Cooney, Carisa M.; Rosson, Gedge D.

doi:10.1097/prs.0000000000004105

Cited by 23 publications

(12 citation statements)

References 33 publications

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“…20 Radiotherapy is associated with lower scores in physical, sexual, and psychosocial well-being. 21 Lower BREAST-Q quality-of-life scores were associated with more operations, reoperations because of complications, and higher body mass index. 22 In the present study, implant material, autologous versus implant-based reconstruction, and radiotherapy use were not associated with disparity between patient and outsider perceptions of aesthetic outcomes.…”

Section: Discussionmentioning

confidence: 95%

Beauty Is in the Eye of the Beholder: Factors Influencing Disparity in Perceptions of Breast Reconstruction Aesthetic Outcomes

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et al. 2022

Plastic &Amp; Reconstructive Surgery

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Breast cancer is the most common new cancer diagnosis among women. 1 The number of patients with breast cancer who undergo mastectomy in the United States has been increasing since 2005, with more than 30 percent of patients with breast cancer undergoing mastectomy in recent years. 2,3 Following mastectomy, breast reconstruction is increasingly selected as part of the therapy plan. More than half of patients with mastectomy underwent breast reconstruction in 2016, compared to 16 percent in 1996. 4,5 In 2019, 107,000 noncosmetic breast reconstruction procedures were performed in the United States. 6 The increase in breast reconstruction procedures reflects the heightened awareness of breast reconstruction procedures as an option, greater insurance coverage mandated by the Women's Health

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Section: Discussionmentioning

confidence: 95%

Beauty Is in the Eye of the Beholder: Factors Influencing Disparity in Perceptions of Breast Reconstruction Aesthetic Outcomes

Duraes

Scomação

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…In general, PMRT is offered to women with large primary tumors (T3), and with multiple nodal positivity (N2). Post mastectomy radiation therapy after IBR with implants has been reported to decrease satisfaction with the breast, along with physical or sexual well-being of patients [52]. For these reasons, patients should be informed, and this multimodality approach planned within a proper timing.…”

Section: Discussionmentioning

confidence: 99%

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

et al. 2020

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Background: Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants. Methods: A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants. Results: Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0e3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4e16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1e15.7) and 15.8% (95% CI: 4.1e15.7) [p ¼ 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR ¼ 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR ¼ 0.3, p ¼ 0.003). Conclusions: After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto-Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).

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“…25 Yet, many studies using the BREAST-Q to evaluate radiation therapy in the implantbased breast reconstruction setting are limited by study design and/or sample size. 18,21,23,[30][31][32][33][34] Our study provides longitudinal evaluation using the BREAST-Q in a large cohort of women and specifically assesses patient-reported outcomes by timing of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15] Clinical understanding of the impact of radiotherapy on patient-reported outcomes after implant-based breast reconstruction is limited. 14 Most studies are retrospective 10,16 and lack longterm follow-up, 13,17,18 although there are several more recent prospective studies. [19][20][21] For instance, in a recent prospective cohort study by our group, patients with a history of radiotherapy undergoing either autologous reconstruction or implant-based breast reconstruction reported worse long-term outcomes for satisfaction with breast and physical well-being of the chest.…”

mentioning

confidence: 99%

Association of Radiation Timing with Long-Term Satisfaction and Health-Related Quality of Life in Prosthetic Breast Reconstruction

Nelson

Cordeiro

Polanco

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Radiation therapy is increasingly used after breast cancer surgery, which may impact patients’ postoperative quality of life. This study assessed differences in long-term patient satisfaction and health-related quality of life after radiation therapy administered at different stages of implant-based breast reconstruction or with no radiation after surgery. Methods: In this observational study, long-term outcomes were evaluated for four cohorts of women who completed breast reconstruction and received (1) no radiation, (2) radiation before tissue expander placement, (3) radiation after tissue expander placement, or (4) radiation after permanent implant between 2010 and 2017 at Memorial Sloan Kettering. Satisfaction and health-related quality of life were assessed using the prospectively collected Satisfaction with Breasts and Physical Well-Being of Chest BREAST-Q subscales. Score distributions were examined by radiation exposure status for 3 years after surgery using nonparametric analyses and regression models. Results: Of 2932 patients who met the inclusion criteria, 25.8 percent received radiation during breast cancer treatment, including before tissue expander placement (n = 239; 8.2 percent), after tissue expander placement (n = 290; 9.9 percent), and after implant placement (n = 228; 7.8 percent). Radiotherapy patients had average scores 7 to 9 points lower at all postoperative time points for Satisfaction with Breasts and Physical Well-Being of Chest subscales (p < 0.001). Although patient-reported outcomes did not differ by radiation timing, there were higher rates of severe capsular contracture with postimplant radiotherapy (p < 0.001). Conclusions: Radiation therapy significantly affected patient satisfaction and health-related quality of life following implant breast reconstruction through 3 years postoperatively. Patient perception of outcome was unaffected by radiotherapy timing; however, capsular contracture was higher after postimplant radiotherapy, suggesting there may be an advantage to performing radiotherapy before placement of the final reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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The Effect of Radiation on Quality of Life throughout the Breast Reconstruction Process: A Prospective, Longitudinal Pilot Study of 200 Patients with Long-Term Follow-Up

Abstract: Therapeutic, II.

Cited by 23 publications

References 33 publications

Beauty Is in the Eye of the Beholder: Factors Influencing Disparity in Perceptions of Breast Reconstruction Aesthetic Outcomes

Beauty Is in the Eye of the Beholder: Factors Influencing Disparity in Perceptions of Breast Reconstruction Aesthetic Outcomes

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

Association of Radiation Timing with Long-Term Satisfaction and Health-Related Quality of Life in Prosthetic Breast Reconstruction

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