The Effect of Radiotherapy on Implant-based Breast Reconstruction in the Setting of Skin-sparing Mastectomy: Clinical Series and Review of Complications

Background: With the increasing popularity of skin-sparing mastectomy techniques, implant-based breast reconstruction and use of perioperative radiation therapy, there is a growing need to scrutinize the effects they have on breast reconstruction. This study examined the effect of radiation on implant-based breast reconstruction in patients who had skin- sparing or conventional mastectomies in terms of complication, reoperation, and capsular contracture rates. Patients and Methods: A retrospective review of 227 implant-based breast reconstructions in 132 mastectomy patients by a single surgeon was undertaken. All cases occurred over a four-year period (2006-2009) at a single institution. Complication, re-operation, and capsular contracture rates were tabulated against immediate and delayed reconstruction, skin-sparing and conventional mastectomy implant-based reconstruction, and irradiated and non-irradiated groups. Chi-square test was performed for statistical analysis. Results: The overall complication and reoperation rates of 15% and 10% in these 227 reconstructions compare favorably to reviewed series. Delayed reconstruction, skin-sparing mastectomy and irradiation were all associated with a significantly increased rate of re-operation, but not to an increase in complication or capsular contracture rates. Conclusion: The results of this study were more favourable than those of similar studies reported in the current literature, suggesting an increased role for implant- based reconstruction in the setting of adjuvant radiotherapy for patients that undergo skin-sparing mastectomy. Undergoing mastectomy has implications for the psychosocial well-being of the patient and every attempt should be made to reconstruct the breast in suitable patients (1). Skin-sparing mastectomy (SSM) is one of the techniques developed to improve the aesthetic result of breast reconstruction. The concept of preoperative plastic surgery