The Effect of Radiotherapy on Implant-based Breast Reconstruction in the Setting of Skin-sparing Mastectomy: Clinical Series and Review of Complications

With the increasing popularity of skin-sparing mastectomy techniques, implant-based breast reconstruction and use of perioperative radiation therapy, there is a growing need to scrutinize the effects they have on breast reconstruction. This study examined the effect of radiation on implant-based breast reconstruction in patients who had skin-sparing or conventional mastectomies in terms of complication, reoperation, and capsular contracture rates. A retrospective review of 227 implant-based breast reconstructions in 132 mastectomy patients by a single surgeon was undertaken. All cases occurred over a four-year period (2006-2009) at a single institution. Complication, re-operation, and capsular contracture rates were tabulated against immediate and delayed reconstruction, skin-sparing and conventional mastectomy implant-based reconstruction, and irradiated and non-irradiated groups. Chi-square test was performed for statistical analysis. The overall complication and reoperation rates of 15% and 10% in these 227 reconstructions compare favorably to reviewed series. Delayed reconstruction, skin-sparing mastectomy and irradiation were all associated with a significantly increased rate of re-operation, but not to an increase in complication or capsular contracture rates. The results of this study were more favourable than those of similar studies reported in the current literature, suggesting an increased role for implant-based reconstruction in the setting of adjuvant radiotherapy for patients that undergo skin-sparing mastectomy.