title: The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants.
abstract: BACKGROUND
  Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type.
  
  
  METHODS
  One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2-5) years.
  
  
  RESULTS
  The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.
authors.affiliation: Department of Academic Surgery (Breast Unit), Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom.
authors.forename: K A
authors.initials: KA
authors.lastname: Behranwala
authors.forename: R S
authors.initials: RS
authors.lastname: Dua
authors.forename: G M
authors.initials: GM
authors.lastname: Ross
authors.forename: A
authors.initials: A
authors.lastname: Ward
authors.forename: R
authors.initials: R
authors.lastname: A'hern
authors.forename: G P H
authors.initials: GP
authors.lastname: Gui
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003286:Contracture / Q000209:etiology; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012086:Reoperation; D012307:Risk Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome