Breast Reconstruction in Previously Irradiated Patients Using Tissue Expanders and Implants: A Potentially Unfavorable Result

Breast reconstruction with alloplastic implants

“…These complications include pain, infection, implant rupture, wound dehiscence or implant exposure, implant migration, contractures, and, occasionally, a need for implant removal [1,8,9,38,42,47,[50][51][52]. Also, the rate of patients satisfaction with cosmetic outcome ranged widely from 7% to 88%, as compared to 64% to 97% in non-irradiated patients [6,8,40,[44][45][46][47][48]51,53]. The major primary cause of unfavorable cosmetic results in these cases is capsular contracture [1,9,38,42,43,52,54], which is possibly attributed to subclinical infections, hemorrhage, and radiation fibrosis [42,55].…”

“…Tissue expansion should not be attempted during radiotherapy since all the radiation parameters must be modified according to breast contour changes [52]. In patients undergoing radiation therapy before prosthetic reconstruction, expanding irradiated tissue may be more difficult and painful due to its significantly lower elasticity [1,45,48,52]. Expansion is often more gradual and can be complicated by exposure and extrusion of the prosthesis [1,31].…”

“…Expansion is often more gradual and can be complicated by exposure and extrusion of the prosthesis [1,31]. Furthermore, the expanded breast is often too small, hard, constricted, and lacking natural ptosis [1,31,45]. In those patients with significant radiation damage to the skin and subcutaneous tissue, the procedure may have to be abandoned in patients [3,31,48].…”

“…In those patients with significant radiation damage to the skin and subcutaneous tissue, the procedure may have to be abandoned in patients [3,31,48]. These patients may require additional steps in the surgical procedure to achieve a satisfactory result [38,45,46]. On the other hand, in patients with a high likelihood of requiring post-mastectomy irradiation, current recommendations generally suggest delay of breast reconstruction [49,52,54].…”

Radiooncological Aspects Regarding Multimodal Primary Treatment of Breast Cancer – a Review

“…From a therapeutic point of view the most important factors that are subject of deliberate decision in patients requiring adjuvant RT and desiring breast reconstruction are the timing (immediate vs. delayed), the extent and type of oncoplastic surgery, the use of autologous tissues vs. implants, and the sequence of breast reconstructive surgery and irradiation [111,114,115]. Breast reconstruction with the use of expander and implants (E/I) is associated with a considerable risk of complications [112,113,116,117]. Krueger et al [112] reported a rate of reconstruction failures in patients with E/I-reconstruction with additional RT of 37% as compared to 8% for patients without irradiation.…”