A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy |
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Authors: | Helen Jane Thomson Shelley Potter Rosemary Jane Greenwood Amit Bahl Jane Barker Simon John Cawthorn Zoë Ellen Winters |
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Institution: | (1) Department of Clinical Sciences at South Bristol and Bristol Breast Unit, Level 7 Research, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK;(2) Research and Development Support Unit, Level 6, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK;(3) Breast Care Centre, Frenchay Hospital, Frenchay Park Road, Frenchay, Bristol, BS16 1LE, UK |
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Abstract: | Background Immediate breast reconstruction may result in superior cosmetic outcomes as a result of the preservation of the skin envelope.
The impact of implant use and radiotherapy (RT) on the cosmetic outcome of latissimus dorsi (LD) breast reconstruction, however,
has never been prospectively evaluated with adequate long-term follow-up.
Methods Women undergoing immediate LD breast reconstruction from January 2000 to February 2007 underwent photographic assessment and
clinical evaluation for breast retraction analysis (BRA) at 3, 6 and 12 months postoperatively and on the anniversary of their
surgery. The resulting photographs were subject to panel cosmetic assessment. A patient-reported cosmetic outcome questionnaire
and the body image scale (BIS) were administered to each woman at a single time point to coincide with the anniversary of
their surgery. Multilevel linear regression modelling was used to analyse the results.
Results Seventy-three women underwent 53 implant-assisted LD breast reconstructions and 20 autologous procedures with a mean follow-up
of 2.71 years. The incidence of radiotherapy in this cohort was 43%. RT over time adversely influenced overall cosmetic outcome
as assessed by the panel (P = 0.0002), and BRA (P = 0.033), both of which were significantly worse in the implant-assisted group (P = 0.020). Patient reporting of overall cosmetic outcome and BIS, however, did not differ significantly between the LD groups
or following RT.
Conclusion Radiotherapy may adversely affect the cosmetic outcome of latissimus dorsi breast reconstruction, particularly if an implant
is used, but this is not universal. Patient assessment of their cosmetic outcome may, however, differ significantly from the
clinician’s view.
Financial support: Allergan Medical UK, United Bristol Healthcare Trust Charitable Trustees |
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Keywords: | Breast reconstruction Cosmetic Latissimus Prospective Radiotherapy |
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