INTRODUCTION:
Bilateral tissue expander/implant breast reconstruction generally offers women excellent breast symmetry with no donor site morbidity. Not infrequently, however, unilateral postoperative radiotherapy is required.
The purpose of this study is to evaluate complications, capsular contracture, aesthetic outcomes and patient satisfaction in patients who have undergone bilateral tissue expander/implant reconstruction and unilateral, post-exchange, adjuvant radiotherapy. In this study population, the impact of radiation can be best appreciated as the non-radiated breast acts as a control.
METHODS:
Between March 1998 and June 2002, 12 immediate bilateral tissue-expander/implant reconstructions were performed at a single cancer center in patients who required unilateral, post-exchange, adjuvant radiotherapy. Capsular contracture, symmetry, cosmesis and patient satisfaction were prospectively evaluated during a follow-up clinical examination a minimum of six months post-radiation. Patients who received radiotherapy prior to completion of their reconstruction or had previously received chest wall irradiation were excluded.
All patients completed expansion and exchange prior to the start of radiation. Eight patients received bilateral saline implants; four patients received bilateral silicone implants. Cosmetic evaluations and patient satisfaction ratings were performed for 10 of the 12 patients as two were deceased at the time of follow-up.
RESULTS:
Mean patient age was 47.9 years (range 39 to 59 years) and mean follow-up 23.5 months (range 6 to 39 months). Eighty percent of bilateral tissue expander/implant reconstructions in this series demonstrated very good or excellent symmetry. Seven patients (70%) expressed satisfaction with their tissue/expander implant reconstruction. Eight patients (80%) would choose the same method of reconstruction again.
In four patients, there was no discernable difference in capsular contracture between the radiated and non-radiated breasts. In five patients, the radiated breast demonstrated increased contracture by one modified Baker grade. (see Table 1 ) In one patient, contracture of the radiated breast was 2 modified Baker grades greater than the non-radiated side (grade 3 vs. grade 1). There were no grade IV capsular contractures in either the radiated or non-radiated breasts.
CONCLUSION:
In this series of bilateral reconstruction patients, capsular contracture was higher on the radiated side. In spite of this, overall symmetry, aesthetic result and patient satisfaction remained high. This data supports the conclusion that immediate breast reconstruction using bilateral tissue expansion and implants is an acceptable option for patients who may undergo unilateral, postoperative radiotherapy.
TABLE 1.
|
Patient |
Contracture Grade: Radiated Breast |
Contracture Grade: Non-radiated Breast |
Implant Type |
Symmetry |
Aesthetic Result |
Patient Satisfaction |
Would Choose Method Again
|
|
1 |
3 |
1 |
Saline |
Good |
Very good |
N |
Y |
|
2 |
1 |
1 |
Saline |
Excellent |
Excellent |
Y |
Y |
|
3 |
3 |
2 |
Saline |
Excellent |
Excellent |
Y |
Y |
|
4 |
2 |
2 |
Silicone |
Excellent |
Excellent |
Y |
Y |
|
5 |
2 |
1 |
Silicone |
Excellent |
Excellent |
Y |
Y |
|
6 |
3 |
2 |
Saline |
Very good |
Very good |
N |
N |
|
7 |
2 |
1 |
Silicone |
Excellent |
Excellent |
Y |
Y |
|
8 |
2 |
2 |
Silicone |
Very good |
Very good |
Y |
Y |
|
9 |
3 |
3 |
Saline |
Very good |
Good |
Y |
Y |
|
10 |
3 |
2 |
Saline |
Good |
Good |
N |
N |