Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer.
BACKGROUND
Immediate tissue expander/implant-based breast reconstruction (BR) is often avoided when post-mastectomy radiotherapy (PMRT) is planned due to concerns about high complication rates and poor aesthetic outcomes. This study evaluated surgical, aesthetic and quality of life (QoL) outcomes in women undergoing immediate implant-based BR (IIBR) followed by PMRT.


METHODS
Participants were recruited at least six months after completing the final stage of BR. They completed validated on-line questionnaires assessing satisfaction, QoL, distress, body image and regret. Aesthetic outcomes were rated by their operating surgeon through clinical examination and assessed by an independent surgeon using photographs.


RESULTS
Forty-seven participants completed questionnaires and reported good outcomes for QoL (FACT-B = 115; TOI = 73), satisfaction (Breast-Q), distress (Impact of Events scale <4.8 all subscales) and body image (Body Image scale), with a low score on the Decisional Regret scale (mean 12.1). Aesthetic outcomes were rated fair-to-good (Kroll scale). The surgical complication rate was low (expander/implant loss rate 6.4%, wound infection 10.6%, seroma 4.1%). At follow-up, 33 (70.2%) participants retained their permanent implant and 12 (25.5%) converted to a TRAM or DIEP flap; there were two LD flaps.


CONCLUSIONS
This study demonstrated acceptable cosmetic results, high patient satisfaction and low complication rates. It provides evidence that women are willing to accept the potential risks of IIBR in exchange for its benefits including enhanced body image during chemotherapy and PMRT and the possible avoidance of more complicated and costly delayed autologous BR. The results support the importance of access to BR, even in women with high-risk disease.
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia. Electronic address: meagan.brennan@sydney.edu.au.
Meagan E
ME
Brennan
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia. Electronic address: kathy.Flitcroft@melanoma.org.au.
Kathy
K
Flitcroft
Academic Institute, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: drsanjaywarrier@hotmail.com.
Sanjay
S
Warrier
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia. Electronic address: kylielsnook@gmail.com.
Kylie
K
Snook
Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia. Electronic address: andrew.Spillane@melanoma.org.au.
Andrew J
AJ
Spillane
D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000628:therapy*; D003430:Cross-Sectional Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D049291:Seroma / Q000453:epidemiology; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D015626:Tissue Expansion / Q000379:methods; D015625:Tissue Expansion Devices
Breast cancer; Breast reconstruction; Implant reconstruction; Mastectomy; Post-mastectomy radiotherapy