title: The effects of postmastectomy adjuvant radiotherapy on immediate two-stage prosthetic breast reconstruction: a systematic review.
abstract: BACKGROUND
  The authors performed a systematic review of the literature on the outcome of therapy for patients with breast cancer who underwent adjuvant radiotherapy after an immediate two-stage prosthetic breast reconstruction, either following tissue expansion (stage 1) or after removal of the tissue expander and insertion of a final breast implant (stage 2). Their outcomes were compared to those of patients who had reconstruction without postmastectomy irradiation.
  
  
  METHODS
  Electronic database searches were supplemented by a full-text review of possible relevant articles on two-stage prosthetic immediate breast reconstruction and radiotherapy. Delayed or one-stage prosthetic or nonprosthetic breast reconstruction studies were excluded. The primary outcome measured was the reconstruction failure rate with prosthesis loss. Secondary endpoints were capsular contracture and aesthetic outcome.
  
  
  RESULTS
  No randomized controlled trials were identified, and only one prospective, nonrandomized, multicenter trial was found. Reports with more than 15 patients were included; 12 studies had a total of 1853 patients (715 irradiated and 1138 nonirradiated). Adjuvant radiotherapy resulted in a significantly higher reconstruction failure rate in immediate two-stage prosthetic breast reconstruction compared with controls (18.6 percent versus 3.1 percent, p < 0.00001). Radiotherapy particularly increased the failure rate when given after stage 1 (expander) (29.7 percent versus 5 percent, p < 0.00001) but also stage 2 (permanent implant) (7.7 percent versus 1.5 percent, p = 0.0003). There was also an increase in severe capsular contractures and an inferior cosmetic result in the irradiated patients.
  
  
  CONCLUSIONS
  Nonrandomized studies suggest that adjuvant radiotherapy results in a higher risk of reconstruction failure.
authors.affiliation: Westmead and Sydney, New South Wales, Australia From the Department of Plastic and Reconstructive Surgery and the NSW Breast Cancer Institute, Westmead Hospital, and the Macquarie University Cancer Institute, Australian School of Advanced Medicine, Macquarie University.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lam
authors.forename: Frank
authors.initials: F
authors.lastname: Hsieh
authors.forename: John
authors.initials: J
authors.lastname: Boyages
mesh_terms: D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008408:Mastectomy; D015233:Models, Statistical; D018714:Radiotherapy, Adjuvant; D015626:Tissue Expansion; D016896:Treatment Outcome