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 withvolume replacement have been published. autologous breast reconstruction is more natural butleaves donor site morbidity. it provides the opportunity to restore the breast mound without theneed for scars. this study aims to evaluate the complications of radiotherapy after immediatebreast reconstruction with implants in breast cancer patients who submitted to skin sparingmastectomy and nipple sparing mastectomy by taking into consideration the risk factors andmanagement at our institution.methods: the current study prospectively included patients with invasive breast canceradmitted between january and june 2012 who were scheduled for skin sparing mastectomy ornipple sparing mastectomy and axillary dissection followed by immediate breast reconstructionwith implant. patients received adjuvant chemotherapy followed by conventional fractionatedradiation. complications were classified as either minor or major. the minor complicationsincluded capsular contracture (baker 1-2), seroma, minor skin infection and skin dehiscencewithout exposure of the implant. major complications included capsular contracture (baker3-4), severe infection and major wound dehiscence with implant exposure. capsular contracturewas scored according to the modified baker classification.results: the study included 38 patients. of these, 28 had skin sparing mastectomy while10 underwent nipple sparing mastectomy. the overall complication rate was 71%. we observedminor complications in 18 patients while 9 patients had major complications. complicationsoccurred with a median time of 13 months following radiotherapy completion. all minorcomplications were managed conservatively whereas all major complications required repeatsurgery. no loco-regional recurrences occurred during the follow up period.conclusion: we determined that age > 40 years, smoking, diabetes, dose to prosthesis ?45gy, and prosthetic volume exposed to the radiation dose of > 75% were risk factors for thedevelopment of post-radiation complications in an immediately reconstructed breast withimplant after skin sparing mastectomy and nipple sparing mastectomy. adequate selection ofpatients to exclude those who have significant risk to develop complications will lower thecomplication rate, improve surgical techniques, allow better quality of implants, and limit tissuedamage after radiotherapy.