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. 2024 Dec 21;22(1):347.
doi: 10.1186/s12957-024-03618-9.

Complications and patient-reported outcomes after radiotherapy in breast cancer patients undergoing implant-based breast reconstruction: a retrospective study from a large Chinese breast disease center

Tianyi Ma  1   2 , Teng Ma  1   2 , Xiangjun Li  1   2 , Xinyi Sun  1   2 , Weihong Cao  1 , Zhaohe Niu  1 , Haibo Wang  3
Affiliations

Complications and patient-reported outcomes after radiotherapy in breast cancer patients undergoing implant-based breast reconstruction: a retrospective study from a large Chinese breast disease center

Tianyi Ma et al. World J Surg Oncol. .

Abstract

Background: Postmastectomy radiation therapy (PMRT) can influence the outcome of implant-based breast reconstruction (IBBR). This study aims to investigate the complications and patient-reported outcomes (PROs) following PMRT between direct-to-implant (DTI) and tissue expander-to-implant (TEI) reconstruction.

Methods: The retrospective study included breast cancer patients undergoing IBBR and PMRT. Patients were divided into a permanent implant group (PI-PMRT) and a tissue expander group (TE-PMRT). Complications, reconstruction failure, and reoperation were compared between the two groups. PROs were assessed using the BREAST-Q scale.

Results: A total of 203 patients were included: 99 in the PI-PMRT group and 104 in the TE-PMRT group. The incidence of severe capsular contracture was significantly higher in the PI-PMRT group compared to the TE-PMRT group (37.4% vs. 24.0%, p = 0.039). The PI-PMRT group had a significantly lower rate of reconstruction failure (9.1% vs. 19.2%, p = 0.039) and reoperation (13.1% vs. 24.0%, p = 0.046). Multivariate analysis revealed that the absence of mesh (OR = 2.177, p = 0.040) and DTI reconstruction (OR = 1.922, p = 0.046) were independent predictors of severe capsular contracture; the absence of mesh (OR = 4.699, p = 0.015) and TEI reconstruction (OR = 2.429, p = 0.043) were independent predictors of reconstruction failure. BREAST-Q scores indicated greater breast satisfaction in the PI-PMRT group (p = 0.031).

Conclusions: Although DTI reconstruction resulted in a higher risk of severe capsular contracture, the higher risk of reconstruction failure and reoperation in patients undergoing TEI reconstruction was even more concerning. Furthermore, patients were more likely to report greater breast satisfaction with DTI reconstruction. Therefore, DTI reconstruction may be a more appropriate option for patients anticipating PMRT.

Keywords: Breast cancer; Complication; Implant-based breast reconstruction; Patient-reported outcome; Postmastectomy radiation therapy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol complied with governmental guidelines and the Declaration of Helsinki, and was approved by the Institutional Review Committee of the Affiliated Hospital of Qingdao University. Patients enrolled in the study were informed and provided informed consent. Consent for publication: The patient consented to the publication of the case data as a research article. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A flow chart for the registration and grouping of patients. IBBR, implant-based breast reconstruction; DTI, direct-to-implant; TEI, tissue expander-to-implant; PMRT, postmastectomy radiation therapy; PI, permanent implant; TE, tissue expander
See this image and copyright information in PMC

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