Prosthetic Breast Reconstructions and Radiotherapy

Background:  The indication of adjuvant radiotherapy (RT) after mastectomy (Mx) has broadened in recent years resulting in more and more patients who underwent immediate breast reconstruction with a tissue expander receiving irradiation¹ while others undergo Mx for recurrent cancer after previous wide local excision and radiation therapy (WLE + RT). Our retrospective study has been undertaken to examine the outcome of patients with immediate 2-staged prosthetic breast reconstruction (IBR) after Mx, with or without adjuvant RT or previous WLE + RT.

Methods:  A total of 670 files of prosthetic BR performed by TL between June 1998 and December 2010 were reviewed.  Data was collected on 438 patients (65.3%) who underwent an IBR after Mx with or without adjuvant RT or previous WLE+RT.

Results: Amongst 438 patients who underwent 2-staged IBR during the study period, there were 98 who received adjuvant RT after their mastectomy and insertion of a tissue expander. Another 20 patients underwent Mx for recurrent breast cancer after previous WLE & RT. 

There were 13 failures in the non-RT group (4%) and 18 in the RT group (18.3%) (p=0.001). Three out of 18 (16.7%) who failed in the RT group smoked compared to 3 of of 13 in the non-RT group (23.1%) (p=0.6). Of the 20 patients with previous WLE+RT, there was no failures.

Conclusion:  Patients who undergo immediate 2-staged breast reconstruction have a significantly higher implant loss rate which is not significantly higher for smokers. However, previous WLE+RT is not a contraindication to IBR after a mastectomy for recurrence.