Complications and Cosmesis in Immediate Breast Implant Reconstruction in the Setting of Post Mastectomy Radiation Therapy

Author(s): Janaki Krithika Chandramohan, Yusuf Althawadi, Hamad Salman Saif, Noof Alshaibani, Ashish Rustogi

Background and objectives: Post mastectomy radiation therapy (PMRT) is integral for oncological safety in patients of high-risk category, and breast reconstruction has posed significant challenges for PMRT planning in these patients. Our study explores the cosmetic outcomes and complications of PMRT on breast implants. We compared patient demographics, tumour characteristics, implants and radiation protocol to identify risks for complications and cosmesis.

Methods: The study was conducted on 86 patients who had undergone nipple/skin sparing mastectomy with immediate implant reconstruction. Cosmesis was evaluated in patient’s perspective by using BREAST-Q questionnaire and the complication rates were assessed by rate of hospital admissions and repeat surgeries for implant related issues.

Results: Seroma and capsular contracture were the commonest early and delayed complications respectively. Additional scar boost caused higher rate of necrotic complications and implant loss. Axillary dissection and adjuvant chemotherapy significantly influenced PMRT related implant complications. Cosmetic outcome and patient satisfaction were desirable in over 75% of the patients, affirming the benefits over risks of PMRT.

Conclusion: PMRT related implant complications can be minimised with highly desirable cosmetic outcomes, by proper patient selection, case-bycase tailoring of radiation and good interdisciplinary management.

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