title: Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy.
abstract: OBJECTIVE
  This study evaluates the incidence of local complications after immediate breast reconstruction (IBR) following mastectomy with a subpectorally placed silicone prosthesis, with emphasis on the effect of radiation treatment on IBR.
  
  
  METHODS
  The medical records of 100 women, who underwent a mastectomy followed by IBR with a subpectorally placed silicone prosthesis at the University Hospital Rotterdam/Daniel den Hoed Cancer Center, between March 1990 and March 1995, were reviewed. Thirteen prostheses were implanted prior to radiation treatment, and 15 prostheses were implanted after irradiation of the chest wall.
  
  
  RESULTS
  Early complications were seen in 15% of the IBR and were more often in irradiated women. At long-term follow-up, the most common complication was capsular contracture (21%). This occurred significantly more around prostheses placed in a previously irradiated area (P<0.0005), or which were irradiated after IBR (P=0.001). Loss of prosthesis was seen in 11 cases, and was significantly (P<0.005) more in irradiated women (n=5; 18%) compared to women who were not irradiated (n=6; 7%).
  
  
  CONCLUSIONS
  Complications after IBR with a silicone prosthesis were more common in women who were treated with radiotherapy prior to or after IBR following mastectomy than in women who were not irradiated. In particular, capsular contracture around a prosthesis placed in a previously irradiated area was significantly increased. The use of musculocutaneous flaps, such as the transverse rectus abdominis muscle or latissimus dorsi flap, is preferable for reconstruction of previously irradiated breasts. There is no indication to remove the prosthesis before radiation therapy of the chest wall.
authors.affiliation: Department of Surgical Oncology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Contant
authors.forename: A N
authors.initials: AN
authors.lastname: van Geel
authors.forename: B
authors.initials: B
authors.lastname: van der Holt
authors.forename: C
authors.initials: C
authors.lastname: Griep
authors.forename: R
authors.initials: R
authors.lastname: Tjong Joe Wai
authors.forename: T
authors.initials: T
authors.lastname: Wiggers
mesh_terms: D000328:Adult; D001940:Breast / Q000528:radiation effects*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D003286:Contracture / Q000209:etiology; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015411:Mastectomy, Modified Radical; D008499:Medical Records; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies; D012828:Silicones
chemical_list: D012828:Silicones