Immediate reconstruction with an expander/implant following ablatio mammae because of breast cancer : side effects and cosmetic results after adjuvant chest wall radiotherapy.
OBJECTIVE
Timing and sequencing of radiotherapy in the context of allogenous breast reconstruction have not been standardized. The aim of the present study was to assess the influence of adjuvant radiotherapy on morbidity and patient satisfaction after allogenous breast reconstruction.


METHODS
33 patients underwent mastectomy between 1999 and 2008 and had immediate breast reconstruction with an expander placement in subpectoral/epipectoral location. 24 patients had adjuvant chemotherapy. Adjuvant external-beam radiotherapy with a median dose of 50.4 Gy was given after expander filling and on average 5.2 months prior to placement of the definitive implant. 22 patients with the definitive implant were considered for analysis of capsular fibrosis rate. Questionnaires were sent to all patients to assess cosmetic outcome and satisfaction.


RESULTS
Acute adverse effects were comparable to adjuvant radiotherapy after breast-conserving surgery, resulting in an erythema rate grade 1/2/3 in 21.2%/66.7%/6.1% of patients, respectively. After a mean follow-up of 24.9 months, 9.1%/18.2%/15.2%/9.1% of patients presented a capsular fibrosis grade 1/2/3/4, respectively. Severe deformation/asymmetry of the reconstructed breast was seen in 27.3%/33.3% of patients, respectively. Of the 22 patients with definitive implant, five (22.7%) lost the implant due to painful capsular fibrosis. Of these 22 patients, 50% were very satisfied or satisfied with the reconstruction result. Overall, 81% of patients would request breast reconstruction again.


CONCLUSIONS
Adjuvant radiotherapy with the use of a subtotally filled expander prior to definitive allogenous breast reconstruction is feasible with acceptable morbidity. An interdisciplinary consultation concerning the cosmetic outcome and potential side effects is absolutely necessary.
Piroth
Marc D
MD
Department of Radiotherapy, University Hospital, RWTH Aachen, Aachen, Germany. mpiroth@ukaachen.de
Piroth
Daniela M
DM
Pinkawa
Michael
M
Woodruff
Seth G
SG
Holy
Richard
R
Eble
Michael J
MJ
D001940:Breast / Q000473:pathology / Q000528:radiation effects; D018427:Breast Implants; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003299:Cooperative Behavior; D004954:Esthetics; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008197:Lymph Node Excision; D016462:Mammaplasty; D008408:Mastectomy; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011832:Radiation Injuries / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015625:Tissue Expansion Devices