Keywords
Immediate breast reconstruction
Radiotherapy
Post-mastectomy
Complications
Submitted : 2024-06-23
Accepted : 2024-07-08
Published : 2024-07-23
Abstract
Background and objective: Immediate breast reconstruction not only reduces the number of surgeries for patients after mastectomy but also decreases psychological and physical trauma, making it increasingly popular. However, there is currently no consensus on the integration of post-mastectomy radiotherapy (PMRT) with reconstruction techniques. This review evaluates the impact of PMRT on complications following immediate breast reconstruction, providing guidance for clinical treatment decisions. Methods: PubMed, Web of Science, Embase, and other databases were searched for studies published in the past 15 years on outcomes of implant-based breast reconstruction in the context of radiotherapy to identify articles for analysis. RevMan 5.4 software was used to analyze the risks of seroma, infection, wound dehiscence, flap necrosis, implant exposure, capsule contracture, and reconstruction failure. Results: A total of 11 relevant studies were included, comprising 6323 cases of immediate breast reconstruction. It was found that breasts receiving postoperative irradiation had a significantly increased risk of complications, with statistically significant differences in seroma (P = 0.004), infection (P < 0.00001), wound dehiscence (P = 0.04), implant exposure (P < 0.00001), capsule contracture (P < 0.00001), and reconstruction failure (P < 0.00001). There was no statistically significant difference in flap necrosis (P = 0.88). Conclusion: The results indicate that postoperative radiotherapy significantly increases the risk of complications for patients undergoing immediate implant-based reconstruction. Preventive measures may be taken in advance with the assistance of healthcare providers if necessary.
References
Sung H, Ferlay J, Siegel RL, et al., 2021, Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 71(3): 209–249.
Arnold M, Morgan E, Rumgay H, et al., 2022, Current and Future Burden of Breast Cancer: Global Statistics for 2020 and 2040. Breast, 66: 15–23.
Curigliano G, Burstein HJ, Gnant M, et al., 2023, Understanding Breast Cancer Complexity to Improve Patient Outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol, 34(11): 970–986.
Chen Y, Wu S, 2022, Surgical Treatment of Hereditary Breast Cancer. Surgical Theory and Practice, 27(05): 392–395.
EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, et al., 2014, Effect of Radiotherapy After Mastectomy and Axillary Surgery on 10-Year Recurrence and 20-Year Breast Cancer Mortality: Meta-Analysis of Individual Patient Data for 8135 Women in 22 Randomised Trials. Lancet, 383(9935): 2127–2135.
Gradishar WJ, Moran MS, Abraham J, et al., 2023, NCCN Guidelines® Insights: Breast Cancer, Version 4. J Natl Compr Canc Netw., 21(6): 594–608.
Ilonzo N, Tsang A, Tsantes S, et al., 2016, Breast Reconstruction After Mastectomy: A Ten-Year Analysis of Trends and Immediate Postoperative Outcomes. Breast, 32: 7–12.
Spear SL, Baker JL, 1995, Classification of Capsular Contracture After Prosthetic Breast Reconstruction. Plast Reconstr Surg, 96: 1119–1123
Wells GA, Shea B, O’Connell D, Peterson J, et al., 2021, The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, The Ottawa Hospital Research Institute, viewed March 8, 2022, https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Sun L, Zhu W, Zhang J, et al., 2022, The Risk Factors and the Relationship Between Radiation Dose and Complications and Prosthetic Reconstruction Failure in Patients with Post-Mastectomy Breast Implant Reconstruction: A Retrospective Cohort Study. Gland Surg, 11(11): 1817–1831.
Muresan H, Lam G, Cooper BT, et al., 2017, Impact of Evolving Radiation Therapy Techniques on Implant-Based Breast Reconstruction. Plast Reconstr Surg, 139(6): 1232e–1239e.
Chiasson KF, Kumbla PA, Restrepo RD, et al., 2020, Immediate Latissimus Dorsi and Prosthetic Reconstruction in the Setting of Postmastectomy Radiation: An Analysis of 376 Breast Reconstructions. Ann Plast Surg, 84(6S Suppl 5): S364–S368.
Lardi AM, Ho-Asjoe M, Junge K, et al., 2017, Capsular Contracture in Implant Based Breast Reconstruction: The Effect of Porcine Acellular Dermal Matrix. Gland Surg, 6(1): 49–56.
Peter G, Cordeiro, Albornoz CR, McCormick B, et al., 2015, What is the Optimum Timing of Postmastectomy Radiotherapy in Two-Stage Prosthetic Reconstruction: Radiation to the Tissue Expander or Permanent Implant? Plast Reconstr Surg, 135(6): 1509–1517.
Muresan H, Lam G, Cooper BT, et al., 2017, Impact of Evolving Radiation Therapy Techniques on Implant-Based Breast Reconstruction. Plast Reconstr Surg, 139(6): 1232e–1239e.
Drucker-Zertuche M, Bargallo-Rocha E, Zamora-Del RR, 2011, Radiotherapy and Immediate Expander/Implant Breast Reconstruction: Should Reconstruction Be Delayed? Breast J, 17(4): 365–370.
Naoum GE, Ioakeim MI, Shui AM, et al., 2022, Radiation Modality (Proton/Photon), Timing, and Complication Rates in Patients with Breast Cancer Receiving 2-Stages Expander/Implant Reconstruction. Pract Radiat Oncol, 12(6): 475–486.
Ho AL, Bovill ES, Macadam SA, et al., 2014, Postmastectomy Radiation Therapy after Immediate Two-Stage Tissue Expander/Implant Breast Reconstruction: A University of British Columbia Perspective. Plast Reconstr Surg, 134: 1e–10e.
Sbitany H, Wang F, Peled AW, et al., 2014, Immediate Implant-Based Breast Reconstruction Following Total Skin-Sparing Mastectomy: Defining the Risk of Preoperative and Postoperative Radiation Therapy for Surgical Outcomes. Plast Reconstr Surg, 134(3): 396–404.
Naoum GE, Salama L, Niemierko A, et al., 2019, 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. Int J Radiat Oncol Biol Phys, 106(3): 514–524.
Jagsi R, Jiang J, Momoh AO, et al., 2014, Trends and Variation in Use of Breast Reconstruction in Patients with Breast Cancer Undergoing Mastectomy in the United States. J Clin Oncol, 32(9): 919–926.
Overgaard M, Hanne MN, Tramm T, et al., 2022, Postmastectomy Radiotherapy in High-Risk Breast cancer Patients Given Adjuvant Systemic Therapy. A 30-Year Long-Term Report from the Danish Breast Cancer Cooperative Group DBCG 82bc Trial. Radiother Oncol, 170: 4–13.
Ricci JA, Epstein S, Momoh AO, et al., 2017, A Meta-Analysis of Implant-Based Breast Reconstruction and Timing of Adjuvant Radiation Therapy. J Surg Res, 218: 108–116.
Hoejvig JH, Pedersen NJ, Gramkow CS, et al., 2019, Delayed Two-Stage Breast Reconstruction: The Impact of Radiotherapy. J Plast Reconstr Aesthet Surg, 72(11): 1763–1768.
Eriksson M, Anveden L, Celebioglu F, et al., 2013, Radiotherapy in Implant-Based Immediate Breast Reconstruction: Risk Factors, Surgical Outcomes, and Patient-Reported Outcome Measures in a Large Swedish Multicenter Cohort. Breast Cancer Res Treat, 142(3): 591–601.
Lee K-T, Mun G-H, 2017, Optimal Sequencing of Postmastectomy Radiotherapy and Two Stages of Prosthetic Reconstruction: A Meta-Analysis. Ann Surg Oncol, 24(5): 1262–1268.
Jagsi R, Jiang J, Momoh AO, et al., 2015, Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis. Ann Surg, 263(2): 219–227.
Wang F, Peled AW, Chin R, et al., 2015, The Impact of Radiation Therapy, Lymph Node Dissection, and Hormonal Therapy on Outcomes of Tissue Expander-Implant Exchange in Prosthetic Breast Reconstruction. Plast Reconstr Surg, 137(1): 1–9.