Behranwala, K. A., Dua, R. S., Ross, G. M., Ward, A., A'Hern, R., Gui, G. P. H. (2006) The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants. JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, 59 (10). pp. 1043-1051. ISSN 1748-6815

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Abstract

BACKGROUND: Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. METHODS: One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2-5) years. RESULTS: The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.

Item Type:	Article
Authors (ICR Faculty only):	Ahern, Roger and Ross, Gillian
All Authors:	Behranwala, K. A., Dua, R. S., Ross, G. M., Ward, A., A'Hern, R., Gui, G. P. H.
Uncontrolled Keywords:	immediate breast reconstruction; biodimensional implants; breast cancer; capsule formation Previously irradiated patients; potentially unfavorable result; tissue expansion; patient satisfaction; radiation-therapy; follow-up; complications; mastectomy; aug
Research teams:	Clinical Units > Breast Unit
Depositing User:	EPrints Services
Date Deposited:	10 Aug 2007 20:55
Last Modified:	10 Feb 2010 11:47
URI:	http://publications.icr.ac.uk/id/eprint/2664

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