title: Expander/implant breast reconstruction before radiotherapy: outcomes in a single-institute cohort.
abstract: OBJECTIVE
  Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes.
  
  
  METHODS
  From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy.
  
  
  RESULTS
  At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good (κ-value 0.64; 95% CI: 0.48-0.79).
  
  
  CONCLUSIONS
  RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent.
authors.affiliation: Radiation Oncology Section, Department of Surgery, Radiology and Dentistry, University of Perugia and Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06156, Perugia, Italy. cynthia.aristei@unipg.it
authors.forename: C
authors.initials: C
authors.lastname: Aristei
authors.forename: L
authors.initials: L
authors.lastname: Falcinelli
authors.forename: V
authors.initials: V
authors.lastname: Bini
authors.forename: I
authors.initials: I
authors.lastname: Palumbo
authors.forename: A
authors.initials: A
authors.lastname: Farneti
authors.forename: R P
authors.initials: RP
authors.lastname: Petitto
authors.forename: S
authors.initials: S
authors.lastname: Gori
authors.forename: E
authors.initials: E
authors.lastname: Perrucci
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D020878:Device Removal; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012307:Risk Factors; D015625:Tissue Expansion Devices; D016896:Treatment Outcome