Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience
Background: Breast cancer is the most frequent malignant tumor in women worldwide. In recent years, defined reconstruction principles along with numerous surgical techniques with volume replacement have been published. Autologous breast reconstruction is more natural but leaves donor site morbidi...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Shiraz University of Medical Sciences
2016-01-01
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| Series: | Middle East Journal of Cancer |
| Subjects: | |
| Online Access: | http://mejc.sums.ac.ir/index.php/mejc/article/view/326/247 |
| _version_ | 1819123729024679936 |
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| author | Heba G. El-Sheredy Rabie Ramadan Yasser Hamed |
| author_facet | Heba G. El-Sheredy Rabie Ramadan Yasser Hamed |
| author_sort | Heba G. El-Sheredy |
| collection | DOAJ |
| description | Background: Breast cancer is the most frequent malignant tumor in women worldwide.
In recent years, defined reconstruction principles along with numerous surgical techniques with
volume replacement have been published. Autologous breast reconstruction is more natural but
leaves donor site morbidity. It provides the opportunity to restore the breast mound without the
need for scars. This study aims to evaluate the complications of radiotherapy after immediate
breast reconstruction with implants in breast cancer patients who submitted to skin sparing
mastectomy and nipple sparing mastectomy by taking into consideration the risk factors and
management at our institution.
Methods: The current study prospectively included patients with invasive breast cancer
admitted between January and June 2012 who were scheduled for skin sparing mastectomy or
nipple sparing mastectomy and axillary dissection followed by immediate breast reconstruction
with implant. Patients received adjuvant chemotherapy followed by conventional fractionated
radiation. Complications were classified as either minor or major. The minor complications
included capsular contracture (Baker 1-2), seroma, minor skin infection and skin dehiscence
without exposure of the implant. Major complications included capsular contracture (Baker
3-4), severe infection and major wound dehiscence with implant exposure. Capsular contracture
was scored according to the modified Baker classification.
Results: The study included 38 patients. Of these, 28 had skin sparing mastectomy while
10 underwent nipple sparing mastectomy. The overall complication rate was 71%. We observed
minor complications in 18 patients while 9 patients had major complications. Complications
occurred with a median time of 13 months following radiotherapy completion. All minor
complications were managed conservatively whereas all major complications required repeat
surgery. No loco-regional recurrences occurred during the follow up period.
Conclusion: We determined that age >40 years, smoking, diabetes, dose to prosthesis ≥45
Gy, and prosthetic volume exposed to the radiation dose of >75% were risk factors for the
development of post-radiation complications in an immediately reconstructed breast with
implant after skin sparing mastectomy and nipple sparing mastectomy. Adequate selection of
patients to exclude those who have significant risk to develop complications will lower the
complication rate, improve surgical techniques, allow better quality of implants, and limit tissue
damage after radiotherapy. |
| first_indexed | 2024-12-22T07:12:58Z |
| format | Article |
| id | doaj.art-7eabcf5119d74f8eb787f386eda19369 |
| institution | Directory Open Access Journal |
| issn | 2008-6709 2008-6687 |
| language | English |
| last_indexed | 2024-12-22T07:12:58Z |
| publishDate | 2016-01-01 |
| publisher | Shiraz University of Medical Sciences |
| record_format | Article |
| series | Middle East Journal of Cancer |
| spelling | doaj.art-7eabcf5119d74f8eb787f386eda193692022-12-21T18:34:27ZengShiraz University of Medical SciencesMiddle East Journal of Cancer2008-67092008-66872016-01-01715362Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s ExperienceHeba G. El-Sheredy0Rabie Ramadan1Yasser Hamed2Cancer Management and Research Department, Medical Research Institute, Alexandria University, Alexandria, EgyptDepartment of Surgery, Medical Research Institute, Alexandria University, Alexandria, EgyptDepartment of Surgery, Medical Research Institute, Alexandria University, Alexandria, EgyptBackground: Breast cancer is the most frequent malignant tumor in women worldwide. In recent years, defined reconstruction principles along with numerous surgical techniques with volume replacement have been published. Autologous breast reconstruction is more natural but leaves donor site morbidity. It provides the opportunity to restore the breast mound without the need for scars. This study aims to evaluate the complications of radiotherapy after immediate breast reconstruction with implants in breast cancer patients who submitted to skin sparing mastectomy and nipple sparing mastectomy by taking into consideration the risk factors and management at our institution. Methods: The current study prospectively included patients with invasive breast cancer admitted between January and June 2012 who were scheduled for skin sparing mastectomy or nipple sparing mastectomy and axillary dissection followed by immediate breast reconstruction with implant. Patients received adjuvant chemotherapy followed by conventional fractionated radiation. Complications were classified as either minor or major. The minor complications included capsular contracture (Baker 1-2), seroma, minor skin infection and skin dehiscence without exposure of the implant. Major complications included capsular contracture (Baker 3-4), severe infection and major wound dehiscence with implant exposure. Capsular contracture was scored according to the modified Baker classification. Results: The study included 38 patients. Of these, 28 had skin sparing mastectomy while 10 underwent nipple sparing mastectomy. The overall complication rate was 71%. We observed minor complications in 18 patients while 9 patients had major complications. Complications occurred with a median time of 13 months following radiotherapy completion. All minor complications were managed conservatively whereas all major complications required repeat surgery. No loco-regional recurrences occurred during the follow up period. Conclusion: We determined that age >40 years, smoking, diabetes, dose to prosthesis ≥45 Gy, and prosthetic volume exposed to the radiation dose of >75% were risk factors for the development of post-radiation complications in an immediately reconstructed breast with implant after skin sparing mastectomy and nipple sparing mastectomy. Adequate selection of patients to exclude those who have significant risk to develop complications will lower the complication rate, improve surgical techniques, allow better quality of implants, and limit tissue damage after radiotherapy.http://mejc.sums.ac.ir/index.php/mejc/article/view/326/247Immediate reconstructionBreast cancerAdjuvant radiotherapyComplicationsCapsular contracture |
| spellingShingle | Heba G. El-Sheredy Rabie Ramadan Yasser Hamed Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience Middle East Journal of Cancer Immediate reconstruction Breast cancer Adjuvant radiotherapy Complications Capsular contracture |
| title | Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience |
| title_full | Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience |
| title_fullStr | Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience |
| title_full_unstemmed | Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience |
| title_short | Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience |
| title_sort | complications of radiotherapy after immediate breast reconstruction with implant risk factors and management our institute s experience |
| topic | Immediate reconstruction Breast cancer Adjuvant radiotherapy Complications Capsular contracture |
| url | http://mejc.sums.ac.ir/index.php/mejc/article/view/326/247 |
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