Single stage immediate breast reconstruction with acellular dermal matrix and implant: Defining the risks and outcomes of post-mastectomy radiotherapy |
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| Affiliation: | 1. Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;2. EMGO Institute for Health and Care Research Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;3. Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands;4. Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands;5. Department of Epidemiology & Biostatistics, VU University Medical Centre, De Boelelaan 1089, 1081 HV Amsterdam, The Netherlands;6. MOVE Research Institute Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;1. Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States;2. National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Rd, North Campus Research Complex, Building 16, Ann Arbor, MI United States;3. Center for Statistical Consultation and Research, Department of Biostatistics, 915 E. Washington St., 3550 Rackham, Ann Arbor, MI, United States |
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| Abstract: | IntroductionThe objective of this study is to evaluate outcomes and complications in patients with single-stage ADM-implant based immediate breast reconstruction with and without radiotherapy (RT), highlighting the effects of RT on the reconstruction.Materials and methodsThis prospective study recruited 91 consecutive patients who underwent skin-sparing, nipple-sparing or wise-pattern skin reduction mastectomy with direct-to-implant breast reconstruction with ADMs using sub-pectoral or pre-pectoral approach at the two breast units. Early and late complications like seroma, delayed wound healing, wound breakdown, infection, capsular contracture, implant loss and revision surgery were evaluated in the RT and non-RT groups.ResultsIn the total cohort of 91 patients, 29 received adjuvant RT and 62 did not need RT. In the RT group, 3–7% of them had early complications like seroma, wound infections and delayed healing. 20.7% had post-RT capsular contractures which either required revision surgery with autologous flap (6.9%) or capsulotomy with exchange of implant (6.9%). In the non-RT group, 7–9% cases had seroma & wound infections, 3.06% had delayed wound healing and 7.25% had capsular contracture. 13.04% required revision surgery due to infection, implant loss or failure to achieve expectations. The total loss of implants in the cohort was 7.14% (RT group 6.9% and non-RT group 7.25%). The need for PMRT could have been predicted pre-operatively in the RT group in 55.17% cases based on the extent of disease, multifocality, tumour grade and positive LN status on imaging.ConclusionADM based reconstruction in patients anticipated to receive adjuvant RT is always debatable. Though there is no significant difference in the revision surgeries in our study of the 2 groups, the rate of capsular contracture as expected, was higher in the RT group. Hence, pre-operative discussion on the need for RT highlighting the risks and complications will help patients make a better-informed choice. |
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| Keywords: | Acellular dermal matrix (ADM) Radiotherapy (RT) Post mastectomy radiotherapy (PMRT) Lymph node (LN) |
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