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Delayed-immediate breast reconstruction: An assessment of complications and outcomes in the context of anticipated post-mastectomy radiotherapy

Published:November 22, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.031

      Abstract

      Introduction

      The detrimental effects of post-mastectomy radiotherapy on breast reconstruction are well known. We report our experience with a delayed-immediate approach involving an initial subcutaneous implant with definitive reconstruction after adjuvant radiotherapy.

      Methods

      Patients were identified retrospectively from hospital, theatre and implant registry records. Details regarding demographics, cancer pathology, surgical data and oncological therapies were collected. Primary outcomes included complication rates of first stage surgery and time to definitive reconstruction.

      Results

      115 patients underwent mastectomy and temporary subcutaneous implant (36 nipple sparing) between 2008-2019. Five were smokers with eleven having a BMI > 30. Median age was 46 years (27-76y) and tumour size 50mm. Almost 95% underwent radiotherapy, 82% chemotherapy and 70% had axillary node clearance. Median mastectomy weight was 464g (123-1300g) with median temporary implant volume 375cc (180-655cc). Complications of first stage surgery at three months included 5.2% implant loss (n=6), 14.8% infection rate, 17.4% readmission rate and 10.4% returned to theatre. Reconstructive failure occurred in four cases (3.5%). 76 patients completed definitive reconstruction including 26 autologous, 21 latissimus dorsi with implant and 28 implant only reconstructions. Median time to reconstruction following completion of radiotherapy was 12 months. This increased in those who had implant complications (28 v 15 months) or radiotherapy (16 v 10 months) versus those without.

      Conclusions

      Delayed-immediate breast reconstruction using a temporary subcutaneous implant has been shown to be a safe, feasible and potentially beneficial method compared with simple mastectomy and delayed reconstruction with a complication rate comparable to that of immediate implant reconstruction.

      Keywords

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