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Expander/implant breast reconstruction before radiotherapy

Outcomes in a single-institute cohort

Expander-/Implantatrekonstruktion vor Radiotherapie

Ergebnisse einer Einzelzenterkohorte

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Abstract

Background and purpose

Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes.

Patients and methods

From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy.

Results

At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good (κ-value 0.64; 95% CI: 0.48–0.79).

Conclusion

RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent.

Zusammenfassung

Hintergründe und Ziel

Radiotherapie (RT) rekonstruierter Brüste hatte oft hohe Komplikationsraten und schlechte kosmetische Ergebnisse.

Diese Studie untersuchte Komplikationsraten, Zusammenhänge zwischen Risikofaktoren und Prothesenentfernung sowie kosmetische Ergebnisse.

Patienten und Methoden

Von 1997 bis 2009 erhielten 101 konsekutive Patientinnen eine RT nach Brustrekonstruktion wegen des Vorliegens von Risikofaktoren für ein Rezidiv (92), oder weil es zu einem Rezidiv gekommen war (9).

Zum Zeitpunkt der RT hatten 90 Patienten vorläufige Gewebeexpander und elf dauerhafte Implantate. Zwölf Patienten erhielten eine neo-adjuvante Chemotherapie; alle Patienten erhielten adjuvante Chemo- und/oder Hormon – Therapie.

Ergebnisse

Bei einer mittleren Nachbeobachtungszeit von 50 Monaten kam eine späte Toxizität bei 28 Patientinnen vor: Schmerzen in sieben, Lymphödem in sechs, G1 Hauttoxizität in fünf, subkutane Toxizität in 19 (2G1, 9G2, 7G3, 1G4). Mehr als eine Nebenwirkung hatten zwölf Patientinnen. In acht Patienten rupturierte die Prothese (3), dislozierte (3), dislozierte und rupturierte (1) oder verlor ihre Form (1). Kapselzusammenziehung wurde bei 89 Patientinnen als IA in 14, IB in 47, II in 10, III in 11 und IV in 7 Fällen klassifiziert. Zwölf Prothesen (11,9%) wurden entfernt. Der einzige bedeutende Faktor für die Protheseentfernung war das Alter (p = 0,007). Urteile zu kosmetischen Ergebnissen waren von 81 Ärzten und 84 Patienten verfügbar. Das Ergebnis war auch bei 58/81 der Arzturteile und 57/84 der Patientinneneinschätzungen ausgezeichnet bis gut. Die Inter-Rater-Übereinstimmung über das Ergebnis war insgesamt gut (κ-Wert 0,64; 95-%-CI: 0,48–0,79).

Schlussfolgerung

RT bei rekonstruierten Brüsten hatte niedrige Komplikationsraten in Bezug auf spätere Nebenwirkungen und Prothesenentfernung. Kosmetische Ergebnisse waren überwiegend ausgezeichnet bis gut.

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Acknowledgments

The authors would like to thank Dr. Geraldine A. Boyd for translating and editing this paper.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Radiation Oncology Section, Department of Surgery, Radiology and Dentistry, University of Perugia and Santa Maria della Misericordia Hospital, Sant’Andrea delle Fratte, 06156, Perugia, Italy

    C. Aristei MD & I. Palumbo

  2. Radiation Oncology Division, Santa Maria della Misericordia Hospital, Perugia, Italy

    L. Falcinelli, R.P. Petitto & E. Perrucci

  3. Department of Internal Medicine, University of Perugia, Perugia, Italy

    V. Bini

  4. Radiation Oncology Section, University of Perugia, Perugia, Italy

    A. Farneti

  5. Medical Oncology Division, Santa Maria della Misericordia Hospital, Perugia, Italy

    S. Gori

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  1. C. Aristei MD
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  2. L. Falcinelli
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Correspondence to C. Aristei MD.

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Aristei, C., Falcinelli, L., Bini, V. et al. Expander/implant breast reconstruction before radiotherapy. Strahlenther Onkol 188, 1074–1079 (2012). https://doi.org/10.1007/s00066-012-0231-z

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  • DOI: https://doi.org/10.1007/s00066-012-0231-z

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