title: Outcome of different timings of radiotherapy in implant-based breast reconstructions.
abstract: BACKGROUND
  The therapeutic role of postmastectomy radiation therapy has been demonstrated both in locally advanced breast cancer and in other high-risk conditions. Implant-based breast reconstruction for irradiated patients can generate higher complication rates. In this study, the authors observed the effects of radiation on temporary expanders and permanent implants. The estimate of the totally failed reconstruction rate was the principal endpoint of this study. Capsular contracture rates and patients' and surgeons' subjective evaluations were the secondary endpoints.
  
  
  METHODS
  Two hundred fifty-seven patients were consecutively involved in this study. The population was stratified into two groups: group 1, postmastectomy radiation therapy on permanent implants (n = 109 patients); and group 2, postmastectomy radiation therapy on tissue expanders (n = 50 patients). A nonirradiated control group made up of 98 patients was selected randomly. All patients underwent a two-stage immediate breast reconstruction with subpectoral temporary expanders and permanent implants.
  
  
  RESULTS
  The totally failed reconstruction rate was significantly higher in group 2, with 40 percent of unsuccessful reconstructions compared with 6.4 percent in group 1 and 2.3 percent in the control group (p < 0.0001). The capsular contracture rate was significantly higher for groups 1 and 2 compared with the control group. The shape and symmetry assessment and the patients' opinions demonstrated a higher incidence of good results in group 1 in comparison with group 2. The best scores were always obtained by the control group.
  
  
  CONCLUSIONS
  This study demonstrated that radiotherapy during tissue expansion may compromise the outcome of implant-based breast reconstruction.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Milan, Italy From the Units of Plastic and Reconstructive Surgery, Radiotherapy, and Medical Oncology A, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, and Scuola di Oncologia Chirurgica Ricostruttiva.
authors.forename: Maurizio B
authors.initials: MB
authors.lastname: Nava
authors.forename: Angela E
authors.initials: AE
authors.lastname: Pennati
authors.forename: Laura
authors.initials: L
authors.lastname: Lozza
authors.forename: Andrea
authors.initials: A
authors.lastname: Spano
authors.forename: Milvia
authors.initials: M
authors.lastname: Zambetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Catanuto
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000534:rehabilitation; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D013997:Time Factors; D015626:Tissue Expansion / Q000379:methods; D016896:Treatment Outcome