The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review.

Abstract

BACKGROUND:

The authors performed a systematic review of the literature on the outcome of therapy for patients with breast cancer who underwent adjuvant radiotherapy after an immediate two-stage prosthetic breast reconstruction, either following tissue expansion (stage 1) or after removal of the tissue expander and insertion of a final breast implant (stage 2). Their outcomes were compared to those of patients who had reconstruction without postmastectomy irradiation.

METHODS:

Electronic database searches were supplemented by a full-text review of possible relevant articles on two-stage prosthetic immediate breast reconstruction and radiotherapy. Delayed or one-stage prosthetic or nonprosthetic breast reconstruction studies were excluded. The primary outcome measured was the reconstruction failure rate with prosthesis loss. Secondary endpoints were capsular contracture and aesthetic outcome.

RESULTS:

No randomized controlled trials were identified, and only one prospective, nonrandomized, multicenter trial was found. Reports with more than 15 patients were included; 12 studies had a total of 1853 patients (715 irradiated and 1138 nonirradiated). Adjuvant radiotherapy resulted in a significantly higher reconstruction failure rate in immediate two-stage prosthetic breast reconstruction compared with controls (18.6 percent versus 3.1 percent, p < 0.00001). Radiotherapy particularly increased the failure rate when given after stage 1 (expander) (29.7 percent versus 5 percent, p < 0.00001) but also stage 2 (permanent implant) (7.7 percent versus 1.5 percent, p = 0.0003). There was also an increase in severe capsular contractures and an inferior cosmetic result in the irradiated patients.

CONCLUSION:

Nonrandomized studies suggest that adjuvant radiotherapy results in a higher risk of reconstruction failure.

• Authors: Thomas C Lam, Frank Hsieh, John Boyages
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 132 Issue 3 Pg. 511-518 (Sep 2013) ISSN: 1529-4242 [Electronic] United States
• PMID: 23676964 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Topics

• Breast Implantation (methods)
• Breast Neoplasms (radiotherapy, surgery)
• Female
• Humans
• Mastectomy
• Models, Statistical
• Radiotherapy, Adjuvant
• Tissue Expansion
• Treatment Outcome