The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2006-01, Vol.59 (10), p.1043-1051
• Main Authors: Behranwala, K.A., Dua, R.S., Ross, G.M., Ward, A., A'Hern, R., Gui, G.P.H.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biodimensional implants; Biological and medical sciences; Breast cancer; Breast Implants; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Capsule formation; Contracture - etiology; Esthetics; Female; Gynecology. Andrology. Obstetrics; Humans; Immediate breast reconstruction; Mammaplasty - adverse effects; Mammaplasty - methods; Mammary gland diseases; Mastectomy; Medical sciences; Middle Aged; Neoplasm Invasiveness; Prospective Studies; Radiotherapy, Adjuvant - adverse effects; Reoperation; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Expansion Devices; Treatment Outcome; Tumors
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2006.01.051

Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2–5) years. The mean age of the 114 patients studied was 45 (range, 20–77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation ( p < 0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p < 0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p < 0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.