Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk factors and Management - Our Institute's Experience

Breast cancer is the most frequent malignant tumor in women worldwide. In recent years, defined reconstruction principles along with numerous surgical techniques with volume replacement have been published. Autologous breast reconstruction is more natural but leaves donor site morbidity. It provides the opportunity to restore the breast mound without the need for scars. This study aims to evaluate the complications of radiotherapy after immediate breast reconstruction with implants in breast cancer patients who submitted to skin sparing mastectomy and nipple sparing mastectomy by taking into consideration the risk factors and management at our institution. The current study prospectively included patients with invasive breast cancer admitted between January and June 2012 who were scheduled for skin sparing mastectomy or nipple sparing mastectomy and axillary dissection followed by immediate breast reconstruction with implant. Patients received adjuvant chemotherapy followed by conventional fractionated radiation. Complications were classified as either minor or major. The minor complications included capsular contracture (Baker 1-2), seroma, minor skin infection and skin dehiscence without exposure of the implant. Major complications included capsular contracture (Baker 3-4), severe infection and major wound dehiscence with implant exposure. Capsular contracture was scored according to the modified Baker classification. The study included 38 patients. Of these, 28 had skin sparing mastectomy while 10 underwent nipple sparing mastectomy. The overall complication rate was 71%. We observed minor complications in 18 patients while 9 patients had major complications. Complications occurred with a median time of 13 months following radiotherapy completion. All minor complications were managed conservatively whereas all major complications required repeat surgery. No loco-regional recurrences occurred during the follow up period. We determined that age >40 years, smoking, diabetes, dose to prosthesis ≥45 Gy, and prosthetic volume exposed to the radiation dose of >75% were risk factors for the development of post-radiation complications in an immediately reconstructed breast with implant after skin sparing mastectomy and nipple sparing mastectomy. Adequate selection of patients to exclude those who have significant risk to develop complications will lower the complication rate, improve surgical techniques, allow better quality of implants, and limit tissue damage after radiotherapy.