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The Effects of Postmastectomy Adjuvant Radiotherapy on Immediate Two-Stage Prosthetic Breast Reconstruction: A Systematic Review

Lam, Thomas C. F.R.C.S.(Ed.), F.R.A.C.S.; Hsieh, Frank M.A., M.B., B.Chir.; Boyages, John F.R.A.N.Z.C.R., Ph.D.

Plastic & Reconstructive Surgery: September 2013 - Volume 132 - Issue 3 - p 511–518
doi: 10.1097/PRS.0b013e31829acc41
Breast: Original Articles
Best Paper

Background: The authors performed a systematic review of the literature on the outcome of therapy for patients with breast cancer who underwent adjuvant radiotherapy after an immediate two-stage prosthetic breast reconstruction, either following tissue expansion (stage 1) or after removal of the tissue expander and insertion of a final breast implant (stage 2). Their outcomes were compared to those of patients who had reconstruction without postmastectomy irradiation.

Methods: Electronic database searches were supplemented by a full-text review of possible relevant articles on two-stage prosthetic immediate breast reconstruction and radiotherapy. Delayed or one-stage prosthetic or nonprosthetic breast reconstruction studies were excluded. The primary outcome measured was the reconstruction failure rate with prosthesis loss. Secondary endpoints were capsular contracture and aesthetic outcome.

Results: No randomized controlled trials were identified, and only one prospective, nonrandomized, multicenter trial was found. Reports with more than 15 patients were included; 12 studies had a total of 1853 patients (715 irradiated and 1138 nonirradiated). Adjuvant radiotherapy resulted in a significantly higher reconstruction failure rate in immediate two-stage prosthetic breast reconstruction compared with controls (18.6 percent versus 3.1 percent, p < 0.00001). Radiotherapy particularly increased the failure rate when given after stage 1 (expander) (29.7 percent versus 5 percent, p < 0.00001) but also stage 2 (permanent implant) (7.7 percent versus 1.5 percent, p = 0.0003). There was also an increase in severe capsular contractures and an inferior cosmetic result in the irradiated patients.

Conclusion: Nonrandomized studies suggest that adjuvant radiotherapy results in a higher risk of reconstruction failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Westmead and Sydney, New South Wales, Australia

From the Department of Plastic and Reconstructive Surgery and the NSW Breast Cancer Institute, Westmead Hospital, and the Macquarie University Cancer Institute, Australian School of Advanced Medicine, Macquarie University.

Received for publication December 25, 2012; accepted March 4, 2013.

Disclosure: The authors have no financial interest in any of the products or devices mentioned in this article.

Thomas C. Lam, F.R.C.S.(Ed.), F.R.A.C.S., NSW Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales 2145, Australia, tlam@plasticsurgery.org.au

©2013American Society of Plastic Surgeons