Radiation morbidityIncidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions
Section snippets
Surgical method
Skin-sparing mastectomy was performed through a circumareolar incision. During the period of this study, the methods of non-implant breast reconstruction included free TRAM (transverse rectus abdominis musculocutaneous) flaps, pedicled TRAM flaps, DIEP (deep inferior epigastric perforator) flaps and totally autologous LD (latissimus dorsi) flaps. Implant reconstructions used coverage by an LD flap, and implant-only reconstructions used submuscular placement of the prosthesis.
The prostheses used
Baseline characteristics of the patients
One hundred and seventy-eight combined mastectomy/immediate breast reconstructions were performed at the Cambridge Breast Unit between January 2001 and December 2005 (Table 2). Fifty-eight non-implant reconstructions were excluded from further analysis leaving 120 implant-based immediate reconstructions in the study group (Fig. 1). Of these, 42 reconstructions in 41 patients were irradiated: 37 patients had a unilateral procedure, one had bilateral procedures (both irradiated), and 3 patients
Discussion
There are a number of case series in the literature documenting complications and cosmetic outcome following the immediate breast reconstruction with or without postoperative RT, but interpretation is difficult as most are small retrospective series with variation in both reconstruction techniques and RT schedules. The reported rates of severe CC vary considerably. Most series report crude complication rates, often with relatively short follow-up, and very few quote actuarial complication
Conclusions
This study demonstrates a statistically and clinically significant higher rate of severe CC in patients, who received postoperative RT compared to those who did not. There was no evidence that either chemotherapy or hormonal therapy influenced the development of severe CC. These results may influence women who will require postoperative RT to opt for totally autologous reconstructions, and may also influence the decision whether to give postoperative RT in cases at intermediate risk of
Acknowledgements
Gordon Wishart receives research funding from the Cambridge National Institute of Health Research Biomedical Research Centre.
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