Radiotherapy and implant-based breast reconstruction: a review of outcomes

Abstract

Introduction: Implant‐based breast reconstruction is a popular method for reconstruction after mastectomy for breast cancer. However, published data on outcomes of radiation and implant based breast reconstructions is conflicting. This study aims to examine the associated complications related to prosthetic reconstruction in the setting of irradiation to the chest wall. Methods: This is a single‐centre retrospective study analysing data from January first, 2008 to December 31st, 2017 for implant‐based breast reconstruction procedures post‐mastectomy. Procedures included implant placement and latissimus dorsi (LD) flap with implant. The 30‐day complication and re‐operative complication rates were calculated. Associated risk factors were identified. Results: There was a total of 47 prosthetic based breast reconstructions, 19 received irradiation and 28 did not receive irradiation. All patients received an immediate breast reconstruction after mastectomy and all were single staged. The overall complication rate was comparable between the two groups, at 21.1% and 21.4%, P = .975, respectively for the irradiated and non‐irradiated group. The rate for major complications were also similar between the two groups, 10.5% and 7.1%, P = .683. The rate of severe capsular contracture (Baker's III and IV) between the irradiated and non‐irradiated patients was similar, 5.3% and 7.1%, P = .796. Conclusions: This review suggests that radiotherapy in prosthetic based breast reconstruction is feasible and safe. Failure rates in both groups are not clinically and statistically significant, thus questions the role of expander insertion and a two‐stage operation in the setting of radiotherapy. Implant insertion remains a valid choice for these patients and is an alternative to autologous flaps.