23rd February 2018,
Michelle B Locke, William LE Malins, Jia Le See, John Kenealy
Breast cancer is the most prevalent cancer of women in New Zealand and around the world. Breast reconstruction is commonly undertaken after mastectomy, to improve the quality of life and…
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The Department of Plastic Surgery at Middlemore Hospital has found that the complication rate of patients having implant-based breast reconstruction after radiotherapy for breast cancer treatment have a high complication rate. We now encourage patients to use their own tissue (for example, from their abdomen) to reconstruct their breast(s) if they have had radiotherapy. We have shown a lower complication rate in women who use their own tissue rather than implants for reconstruction following radiotherapy.
External beam radiotherapy (XRT) to the breast has been shown to increase complication rates in women undergoing implant-based breast reconstruction (IBBR). Owing to concerns about high complication and failure rates, our department began to favour autologous reconstructive in patients requiring XRT in 2013. This study assesses the outcomes of IBBR prior to and following this policy change.
The records of all patients who underwent first-stage IBBR in 2012 and 2013 in our department were reviewed. Patients undergoing peri-operative XRT were identified. Complications and failure rates were analysed.
Over two years, 77 IBBRs were performed in 53 patients. In 2012, 11 patients underwent peri-operative XTR compared with five in 2013. Radiotherapy was significantly associated with higher reconstructive failure rates while pre-operative XRT was associated with more complications overall (p=0.0099). Over the two years, the number of IBBRs with any complication fell from 16 (43.2%) to 11 (27.5%) while reconstructive failure fell from six (16.2%) to four (10%).
Peri-operative XRT increases complication rates and reconstructive failure with IBBR. Our current policy of recommending autologous reconstruction if they have had pre-operative XRT seems to be resulting in decreased complication rates and increased reconstructive success.
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