Patient-Reported Outcomes after Irradiation of Tissue Expander versus Permanent Implant in Breast Reconstruction: A Multicenter Prospective Study

Abstract

W e read the article entitled " Patient-Reported Outcomes after Irradiation of Tissue Expander versus Permanent Implant in Breast Reconstruction: A Multicenter Prospective Study" 1 with great interest. We thank the authors for this useful study and would like to ask some questions.The authors researched the uncertainty surrounding the timing of radiation therapy in two-stage breast reconstruction after mastectomy and the effect of radiation therapy timing on complications. In their study, the authors report two different algorithms: radiation therapy of the tissue expander followed by the exchange procedure (237 patients in the before-exchange group) versus radiation therapy to the permanent implant after the exchange procedure (80 patients in the after-exchange group). Complication rates and reconstruction success of these two patient groups were compared.Postmastectomy radiation therapy reduces the risks of locoregional failure, any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. 2 On the other hand, radiotherapy can cause wound healing problems, capsule contracture, and necrosis in mastectomy skin flaps. These complications affect the success of the reconstruction and the quality of the aesthetic result. 3 The use of acellular dermal matrix increases the complication rates (such as infection, seroma) in breast reconstruction. 4,5 Did excessive use of acellular dermal matrix in the before-exchange group cause complications or reconstruction failures?How long was the time interval between mastectomy and expander/permanent implant exchange operation in the two groups (before exchange and after exchange)? On average, how long was the time to start radiation therapy in the two groups? Was there a delay in patients receiving radiation therapy in the after-exchange group? Was any neoadjuvant therapy given to the patients in this group, considering that there may have been a delay in receiving radiotherapy?