title: Skin reducing mastectomy and immediate reconstruction: the effect of radiotherapy on complications and patient reported outcomes.
abstract: OBJECTIVE
  Skin reducing mastectomy, dermal sling and immediate implant reconstruction (SRMIR) is an emerging technique where, de-epithelialised inferior skin flap sutured to pectoralis major provides vascularised, dermal sling for the implant. We aimed to assess patient satisfaction following SRMIR and determine if radiotherapy affected patient reported outcomes.
  
  
  METHODS
  A prospective database of women undergoing SRMIR was analysed. SRMIR was performed in 92 women (116 breasts). Radiotherapy was received by 45 women and it was not required in 47 women. Forty eight women had contralateral surgery: 21 breast reduction/mastopexy, 1 augmentation, 26 mastectomy/reconstruction. A validated breast evaluation questionnaire provided patient reported outcomes.
  
  
  RESULTS
  Median follow up was 20 months. Early complications were similar in both groups, but those in the radiotherapy group had a higher incidence of implant loss (6/45 = 13% vs 1/47 = 2%; p = 0.06) and grade III/IV capsular contracture (11/45 = 24% vs 6/47 = 13%; p = 0.20). The outcome questionnaire was sent to 83 women who were disease free and had retained their implants. Sixty three women responded (76%). Patient reported satisfaction was high, with or without radiotherapy. Women receiving radiotherapy gave lower scores, but it was statistically significant only for general appearance and symmetry.
  
  
  CONCLUSIONS
  Although complications after radiotherapy are higher in patients who had SRMIR, the majority of women who retained their implant are highly satisfied with their reconstruction. Majority of these patients were happy to recommend SRMIR procedure to their friend.
authors: Department of Breast Surgery, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wednesfield Road, Wolverhampton WV10 0QP, UK. Electronic address: vkorwar@hotmail.co.uk.
authors: V
authors: V
authors: Korwar
authors: Department of Breast Surgery, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wednesfield Road, Wolverhampton WV10 0QP, UK.
authors: J
authors: J
authors: Skillman
authors: Department of Breast Surgery, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wednesfield Road, Wolverhampton WV10 0QP, UK.
authors: P
authors: P
authors: Matey
mesh_terms: D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D057566:Self Report; D012867:Skin; D013524:Surgical Flaps / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Breast cancer; Breast implant; Breast reconstruction; Dermal sling; Radiotherapy; Single stage breast reconstruction; Skin reducing mastectomy