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Higher reconstruction failure and less patient-reported satisfaction after post mastectomy radiotherapy with immediate implant-based breast reconstruction compared to immediate autologous breast reconstruction

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Abstract

Purpose

To improve shared decision making, clinical- and patient-reported outcomes between immediate implant-based and autologous breast reconstruction followed by postmastectomy radiotherapy (PMRT) were compared.

Methods

All women with in situ and/or invasive breast cancer who underwent skin sparing mastectomy with immediate breast reconstruction (IBR) (autologous- or implant based, one- or two staged) followed by PMRT in the Utrecht region between 2012 and 2016 were selected from the Netherlands Cancer Registry, of which 112 (59%) agreed to participate. The primary outcome was reconstruction failure after the start of radiotherapy, and secondary outcomes were patient-reported outcomes measured with BREAST-Q.

Results

109 patients underwent skin-sparing mastectomy, of which 29 (27%) underwent immediate autologous reconstruction and 80 (73%) received immediate implant-based reconstruction. After PMRT, reconstruction failure occurred in 17 patients (21%) with implant-based reconstruction, while no failure was seen in the autologous group (p = 0.04). Mean patient-reported ‘Satisfaction with Breasts’ (50.9 vs. 63.7, p = 0.001) and ‘Sexual Well-being’ (46.0 vs. 55.5, p = 0.037) were lower after implant-based reconstruction compared to autologous reconstruction. Thirteen patients with autologous flaps underwent surgical cosmetic corrections compared to ten patients in the implant group (45 vs. 13%, p = 0.001). IBR and PMRT in this study resulted in a high rate of severe capsular contraction in implant-based reconstruction (16.9%) and fibrosis in autologous reconstruction (13.8%).

Conclusions

Patients treated with PMRT and one or two stage immediate implant-based reconstruction were at greater risk of develo** reconstruction failure and were less satisfied when compared to one or two stage immediate autologous reconstruction. Since fairly high complication rates in both reconstruction methods after PMRT are observed, it raises the question whether immediate breast reconstruction should be considered at all when PMRT is indicated. Patients considering or potential candidates for IBR should be informed about the consequences of PMRT and especially when opting for autologous reconstruction one should possibly perform reconstruction in a secondary setting.

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Data availability

The complete dataset generated during and/or analysed during the current study are not publicly available since individual privacy could be compromised. Encoded parts of the dataset are available from the corresponding author on reasonable request. Some data is generated with the help of the Dutch Cancer Regestration, to share this information permission of the Netherlands Comprehensive Cancer Organisation (IKNL) is needed.

Notes

  1. Dutch Cancer Regestration maintained by the Netherlands Comprehensive Cancer Organisation (IKNL).

  2. VERSION 2.0 May 2015, retrieved at 30–03-2018 from: https://qportfolio.org/breastq/wp-content/uploads/2016/08/Breast-Q-USERS-MANUAL-2015.pdf, Memorial Sloan Kettering Cancer Center and The University British Columbia © 2006, All rights Reserved.

Abbreviations

IBR:

Immediate breast reconstruction

TE:

Tissue expander

PMRT:

Postmastectomy radiotherapy

SNP:

Sentinel node procedure

PROs:

Patient-reported outcomes

ALND:

Axillary lymph node dissection

TEM:

Tissue equivalent material

ADM:

Acellular dermal matrix

ALN:

Axillary lymph nodes

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Acknowledgements

The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice. The authors thank all participating radiation oncologists of the UMC-Utrecht for approaching patients. The authors thank all participating plastic surgeons in the region of Utrecht for their cooperation and advise.

Funding

The authors declare that this study was not funded.

Author information

Authors and Affiliations

  1. Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    F. C. J. Reinders, D. A. Young-Afat, M. C. T. Batenburg & H. M. Verkooijen

  2. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands

    H. J. G. D. van den Bongard

  3. Departments of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    S. E. Bruekers, E. A. van Amerongen, J. F. M. Macaré van Maurik, A. Braakenburg, E. Zonnevylle, M. Hoefkens, T. Teunis & W. Maarse

  4. Departments of Plastic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

    E. A. van Amerongen, J. F. M. Macaré van Maurik, A. Braakenburg, E. Zonnevylle, M. Hoefkens, T. Teunis & W. Maarse

  5. Departments of Plastic Surgery, Diakonessenhuis, Utrecht, The Netherlands

    E. A. van Amerongen, J. F. M. Macaré van Maurik, A. Braakenburg, E. Zonnevylle, M. Hoefkens, T. Teunis & W. Maarse

  6. Departments of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands

    E. A. van Amerongen, J. F. M. Macaré van Maurik, A. Braakenburg, E. Zonnevylle, M. Hoefkens, T. Teunis & W. Maarse

  7. Departments of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands

    E. A. van Amerongen, J. F. M. Macaré van Maurik, A. Braakenburg, E. Zonnevylle, M. Hoefkens, T. Teunis & W. Maarse

  8. Departments of Plastic Surgery, Alexander Monro Hospital, Bilthoven, The Netherlands

    E. A. van Amerongen, J. F. M. Macaré van Maurik, A. Braakenburg, E. Zonnevylle, M. Hoefkens, T. Teunis & W. Maarse

Authors
  1. F. C. J. Reinders
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  2. D. A. Young-Afat
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  3. M. C. T. Batenburg
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  6. J. F. M. Macaré van Maurik
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Corresponding author

Correspondence to W. Maarse.

Ethics declarations

Conflict of interest

F.C.J. Reinders declares that he has no conflict of interest, D.A. Young-Afat declares that he has no conflict of interest, M.C.T. Batenburg declares that she has no conflict of interest, S.E. Bruekers declares that he has no conflict of interest, E.A. van Amerongen declares that she has no conflict of interest, J.F.M. Macaré van Maurik declares that she has no conflict of interest, A. Braakenburg declares that she has no conflict of interest, E. Zonnevylle declares that he has no conflict of interest, M. Hoefkens declares that she has no conflict of interest, T. Teunis declares that she has no conflict of interest, HM Verkooijen declares that she has no conflict of interest, H.J.G.D. van den Bongard declares that she has no conflict of interest and W. Maarse declares that she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Reinders, F.C.J., Young-Afat, D.A., Batenburg, M.C.T. et al. Higher reconstruction failure and less patient-reported satisfaction after post mastectomy radiotherapy with immediate implant-based breast reconstruction compared to immediate autologous breast reconstruction. Breast Cancer 27, 435–444 (2020). https://doi.org/10.1007/s12282-019-01036-4

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