title: Differences in breast aesthetic outcomes due to radiation: A validated, quantitative analysis of expander-implant reconstruction.
abstract: BACKGROUND
  The potential ramifications of radiation use can be of particular concern in the breast reconstruction population, in which both surgical and aesthetic outcomes are important. Presently, there remains a paucity of data detailing the influence of radiation on specific reconstruction aesthetic outcomes.
  
  
  OBJECTIVE
  To conduct a quantitative evaluation of aesthetic outcomes for expander-implant breast reconstruction in radiated and nonradiated patients using a validated scoring scale.
  
  
  METHODS
  A series of consecutive expander-implant breast reconstruction operations performed by the senior author between 2004 and 2012 were reviewed. Four blinded members of the Division of Plastic and Reconstructive Surgery at Northwestern University (Illinois, USA) independently rated postoperative photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains.
  
  
  RESULTS
  Of the 206 patients meeting the inclusion criteria, 69 received radiotherapy and 137 did not. The radiated cohort had lower scores in each aesthetic domain, with significant differences in contour (1.33 versus 1.51; P=0.041) and placement (1.45 versus 1.73; P<0.001). Linear regression analysis revealed a significant association between placement scores and radiation, and radiated patients had a significantly higher overall rate of complications.
  
  
  CONCLUSIONS
  Variances in scores may represent the relative difficulty of expansions and proper implant placement in irradiated tissue, with possible skin fibrosis and decreased flexibility hindering prosthesis manipulation.
  
  
  CONCLUSIONS
  Radiation adversely impacts breast contour and placement, with possible negative contributions to volume, scarring and inframammary fold definition, and results in higher rates of complications. Such detailed evaluation of the impact of radiation on aesthetics will enhance the management of patient expectations.
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee;
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Mioton
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine;
authors.forename: Jessica
authors.initials: J
authors.lastname: Gaido
authors.affiliation: Department of Radiation Oncology, The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine;
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.affiliation: Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine;
authors.forename: John Y
authors.initials: JY
authors.lastname: Kim
keywords: Aesthetic outcomes; Breast reconstruction; Plastic surgery; Radiation; Tissue expander