title: A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy.
abstract: BACKGROUND
  Immediate breast reconstruction may result in superior cosmetic outcomes as a result of the preservation of the skin envelope. The impact of implant use and radiotherapy (RT) on the cosmetic outcome of latissimus dorsi (LD) breast reconstruction, however, has never been prospectively evaluated with adequate long-term follow-up.
  
  
  METHODS
  Women undergoing immediate LD breast reconstruction from January 2000 to February 2007 underwent photographic assessment and clinical evaluation for breast retraction analysis (BRA) at 3, 6 and 12 months postoperatively and on the anniversary of their surgery. The resulting photographs were subject to panel cosmetic assessment. A patient-reported cosmetic outcome questionnaire and the body image scale (BIS) were administered to each woman at a single time point to coincide with the anniversary of their surgery. Multilevel linear regression modelling was used to analyse the results.
  
  
  RESULTS
  Seventy-three women underwent 53 implant-assisted LD breast reconstructions and 20 autologous procedures with a mean follow-up of 2.71 years. The incidence of radiotherapy in this cohort was 43%. RT over time adversely influenced overall cosmetic outcome as assessed by the panel (P = 0.0002), and BRA (P = 0.033), both of which were significantly worse in the implant-assisted group (P = 0.020). Patient reporting of overall cosmetic outcome and BIS, however, did not differ significantly between the LD groups or following RT.
  
  
  CONCLUSIONS
  Radiotherapy may adversely affect the cosmetic outcome of latissimus dorsi breast reconstruction, particularly if an implant is used, but this is not universal. Patient assessment of their cosmetic outcome may, however, differ significantly from the clinician's view.
authors.affiliation: Department of Clinical Sciences at South Bristol and Bristol Breast Unit, Level 7 Research, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK.
authors.forename: Helen Jane
authors.initials: HJ
authors.lastname: Thomson
authors.forename: Shelley
authors.initials: S
authors.lastname: Potter
authors.forename: Rosemary Jane
authors.initials: RJ
authors.lastname: Greenwood
authors.forename: Amit
authors.initials: A
authors.lastname: Bahl
authors.forename: Jane
authors.initials: J
authors.lastname: Barker
authors.forename: Simon John
authors.initials: SJ
authors.lastname: Cawthorn
authors.forename: Zoë Ellen
authors.initials: ZE
authors.lastname: Winters
mesh_terms: D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D017060:Patient Satisfaction; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*