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Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort

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Abstract

The purpose of this large cohort study was to analyze the effects of prior and postoperative radiotherapy (RT) on surgical outcomes and patient-reported outcome measures (PROMs) in implant-based immediate breast reconstruction (IBR). All breast cancer patients (n = 725, of whom 29 had bilateral IBR) operated with implant-based IBR at four Stockholm hospitals from 2007 to 2011 were included. The median follow-up was 43 months. Three groups were compared: no RT (n = 386), prior RT (n = 64), and postoperative RT (n = 304). Outcomes were IBR failure (implant loss with or without secondary autologous reconstruction), unplanned reoperations, and PROMs, as measured by the BreastQ® questionnaire. IBR failure occurred in 22/386 (6 %) of non-irradiated cases, 16/64 (25 %) after prior and 45/304 (15 %) after postoperative RT (p < 0.001). Failure risk was higher after prior than postoperative RT (HR 9.28 vs. 3.08). Further risk factors were high BMI, less surgeon reconstructive experience, and postoperative infection, while the use of permanent implants lowered the risk of IBR failure. The estimated 5 years IBR failure rate was 10.4 % for non-irradiated, 28.2 % for previously and 25.2 % for postoperatively irradiated patients (p < 0.001). At least one unplanned reoperation occurred in 169/384 of non-irradiated (44 %), 42/64 (66 %) of previously, and 180/303 (59 %) of postoperatively irradiated breasts (p < 0.001). Further contributing factors were the use of one-stage expander and permanent implants, less surgeon reconstructive experience, and smoking. RT significantly impaired scores on all scales of the BreastQ®. However, a clear majority of women in all groups would choose IBR again. Implant-based IBR remains a feasible option for women undergoing mastectomy as patient satisfaction levels are high. After prior RT, however, autologous alternatives should be considered.

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Acknowledgments

The authors wish to thank all the participating surgeons for the registration of their patients and all the associated staff for providing support. We are also grateful for the invaluable statistical expertise provided by Hans Pettersson at Karolinska Institutet. JdB was supported by a postdoctoral research grant from the Swedish Society for Medical Research. ME was supported by the Percy Falk Foundation.

Conflict of interest

The authors state that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Semmelweis University, Budapest, Hungary

    Max Eriksson

  2. Department of Surgery, Capio St. Görans Hospital, Stockholm, Sweden

    Lotta Anveden & Catharina Eriksen

  3. Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden

    Fuat Celebioglu & Catharina Eriksen

  4. Department of Clinical Science and Education, Karolinska Institutet, Stockholm South General Hospital, Stockholm, Sweden

    Fuat Celebioglu

  5. Department of Surgery, Danderyd Hospital, Stockholm, Sweden

    Kristina Dahlberg & Ingrid Meldahl

  6. Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden

    Jakob Lagergren

  7. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Jakob Lagergren & Jana de Boniface

  8. Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden

    Jana de Boniface

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  1. Max Eriksson
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Correspondence to Jana de Boniface.

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Eriksson, M., Anveden, L., Celebioglu, F. et al. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat 142, 591–601 (2013). https://doi.org/10.1007/s10549-013-2770-0

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  • DOI: https://doi.org/10.1007/s10549-013-2770-0

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