Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer

Meagan E Brennan; Kathy Flitcroft; Sanjay Warrier; Kylie Snook; Andrew J Spillane

doi:10.1016/j.breast.2016.08.008

Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer

Breast. 2016 Dec:30:59-65. doi: 10.1016/j.breast.2016.08.008. Epub 2016 Sep 7.

Authors

Meagan E Brennan¹, Kathy Flitcroft², Sanjay Warrier³, Kylie Snook⁴, Andrew J Spillane⁵

Affiliations

¹ Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia. Electronic address: [email protected].
² Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia. Electronic address: [email protected].
³ Academic Institute, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: [email protected].
⁴ Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia. Electronic address: [email protected].
⁵ Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia. Electronic address: [email protected].

PMID: 27611237
DOI: 10.1016/j.breast.2016.08.008

Abstract

Background: Immediate tissue expander/implant-based breast reconstruction (BR) is often avoided when post-mastectomy radiotherapy (PMRT) is planned due to concerns about high complication rates and poor aesthetic outcomes. This study evaluated surgical, aesthetic and quality of life (QoL) outcomes in women undergoing immediate implant-based BR (IIBR) followed by PMRT.

Methods: Participants were recruited at least six months after completing the final stage of BR. They completed validated on-line questionnaires assessing satisfaction, QoL, distress, body image and regret. Aesthetic outcomes were rated by their operating surgeon through clinical examination and assessed by an independent surgeon using photographs.

Results: Forty-seven participants completed questionnaires and reported good outcomes for QoL (FACT-B = 115; TOI = 73), satisfaction (Breast-Q), distress (Impact of Events scale <4.8 all subscales) and body image (Body Image scale), with a low score on the Decisional Regret scale (mean 12.1). Aesthetic outcomes were rated fair-to-good (Kroll scale). The surgical complication rate was low (expander/implant loss rate 6.4%, wound infection 10.6%, seroma 4.1%). At follow-up, 33 (70.2%) participants retained their permanent implant and 12 (25.5%) converted to a TRAM or DIEP flap; there were two LD flaps.

Conclusion: This study demonstrated acceptable cosmetic results, high patient satisfaction and low complication rates. It provides evidence that women are willing to accept the potential risks of IIBR in exchange for its benefits including enhanced body image during chemotherapy and PMRT and the possible avoidance of more complicated and costly delayed autologous BR. The results support the importance of access to BR, even in women with high-risk disease.

Keywords: Breast cancer; Breast reconstruction; Implant reconstruction; Mastectomy; Post-mastectomy radiotherapy.

MeSH terms

Adult
Aged
Breast Implantation / methods*
Breast Neoplasms / therapy*
Carcinoma, Ductal, Breast / therapy*
Carcinoma, Lobular / therapy*
Cross-Sectional Studies
Esthetics
Female
Humans
Mammaplasty / methods
Mastectomy / methods*
Middle Aged
Myocutaneous Flap
Patient Satisfaction*
Postoperative Complications / epidemiology
Quality of Life*
Radiotherapy, Adjuvant
Seroma / epidemiology
Surgical Flaps
Surgical Wound Infection / epidemiology
Surveys and Questionnaires
Time Factors
Tissue Expansion / methods
Tissue Expansion Devices