Table S1. Summary of articles.
| Author, country | Title | Year | Level of evidence | Type of article | Timing of reconstruction | Sample population | Follow up | Summary of recommendations | |
|---|---|---|---|---|---|---|---|---|---|
| Kronowitz, USA (63) | Delayed-IBR | 2004 | IV | Case Series | Delayed-immediate | 14 patients (16 breast reconstructions) | Where no radiotherapy is required immediate reconstruction gives the best aesthetic outcome. Where radiotherapy is required, delayed-immediate reconstruction is technically feasible and safe in patients with early-stage breast cancer. With this approach, patients who do not require post-mastectomy radiation therapy can achieve aesthetic outcomes essentially the same as those with immediate reconstruction, and patients who require post-mastectomy radiation therapy can avoid the aesthetic and radiation-delivery problems that can occur after an IBR | ||
| Racano, Italy (15) | Immediate and delayed two-stage post-mastectomy breast reconstruction with implants. Our experience of general surgeons | 2002 | IV | Case Series | Immediate and delayed | 63 patients | 10-36 months | 78% of the women have judged the final aesthetic results the same or better than expected. Reconstruction with prosthesis is the preferred procedure, even with serious complications which do not always influence the final results. This preference is because of the reduced operation time and the psychological and physical benefits due to immediate restoral of the mammary volume and shape | |
| Radovanovic, Serbia (66) | Early complications after nipple-sparing mastectomy and IBR with silicone prosthesis: results of 214 procedures | 2010 | IV | Case Series | Immediate | 205 patients (214 breast reconstructions) | 6 weeks | The overall complication rate at 6-week follow up was 16%. Neoadjuvant chemotherapy and radiotherapy were not associated with higher complication rates. Nipple-sparing mastectomy with immediate implant reconstruction has acceptable morbidity rate in the hand of experienced neoplastic surgeon and therefore should be considered as treatment option to women requiring mastectomy | |
| Robertson, Sweden (19) | Breast surgeons performing IBR with implants - assessment of resource-use and patient-reported outcome measures | 2012 | IV | Case Series | Immediate | 223 patients | 4 years | 41% of patients had received post-mastectomy radiation therapy. A total major complication rate was reported of 19.7%. A total of 1.1 revision operations were required per patient. Our audit showed that trained breast surgeon specialists perform implant-based IBRs and maintain low complication rates. This audit also showed that the IBR does not have a negative impact on the patients’ current state of health | |
| Roostaeian, USA (22) | Immediate placement of implants in breast reconstruction: patient selection and outcomes | 2011 | IV | Case Series | Immediate | 35 patients (43 breast reconstructions) | 15 months | A total of 13 patients (37%) required additional surgery for revision. Revisions were necessary significantly more commonly in patients with a history of radiotherapy, D-cup breast size or greater, and ptosis of grade 2 or more. Immediate implant-based breast reconstruction is a safe and viable option that can provide a very good aesthetic result in appropriately selected candidates. The authors recommend caution and appropriate patient counseling in patients with a history of radiotherapy, larger breasts, and/or ptotic breasts | |
| Rosson, USA (64) | Quality of life before reconstructive breast surgery: A preoperative comparison of patients with immediate, delayed, and major revision reconstruction | 2013 | IV | Case Series | Immediate and delayed | 176 patients | Response rate 76% | The three groups differed significantly (P<0.05) across four of the six domains: body image (satisfaction with breasts), psychosocial well-being, sexual well-being, and physical well-being of the chest and upper body. The immediate reconstruction group had higher (better) scores than the delayed reconstruction group, which had higher (better) scores than the major revision group | |
| Rusby, UK (80) | IBR after mastectomy: what are the long-term prospects? | 2010 | IV | Case Series | Immediate | 95 patients (110 breast reconstructions) | Although more intervention was seen in patients with implant-based reconstruction and the time-course over which autologous and implant-based reconstructions fail is different these did not reach statistical significance. Radiotherapy has a significant effect on failure of implant-based reconstruction | ||
| Salhab, UK (13) | Skin-sparing mastectomy and immediate breast reconstruction: patient satisfaction and clinical outcome. | 2006 | IV | Case Series | Immediate | 21 patients (25 breast reconstructions) | 13.5 months | Skin sparing mastectomy and immediate breast reconstruction for operable breast cancer is associated with a high level of patient satisfaction and low morbidity. The procedure seems to be oncologically safe, even in patients with high-risk (T3 or node-positive) carcinoma. The latter needs to be confirmed with greater numbers of patients and longer follow-up | |
| Snell, USA (12) | Clarifying the expectations of patients undergoing implant breast reconstruction: a qualitative study | 2010 | IV | Case Series | N/A | 28 patients | Implant-based breast reconstruction patients may have inaccurate expectations regarding the results of their surgery despite having received standard preoperative teaching. Specifically, patients often had unclear expectations regarding the appearance and physical outcome of the reconstructed breast(s). Some patients were surprised by the “flatness” of the tissue expander immediately after its insertion. Most patients felt unprepared for the “unnatural” final appearance of the breast(s). This study has important implications for preoperative education of women undergoing implant breast reconstruction. Physicians and nurses involved in the preoperative preparation process should take care to explore patients’ expectations regarding the appearance, feel, sensation, and movement of reconstructed breasts to increase overall postoperative satisfaction | ||
| Yanko-Arzi, Israel (62) | Breast reconstruction: complication rate and tissue expander type | 2009 | IV | Case Series | Immediate and delayed | 140 patients (170 breast reconstructions) | This study compared the incidence of significant complications according type of implant used in breast reconstruction. In reconstructions using anatomic implants a total major complication rate of 41% was found, competed to 20% in round implant use, and 11.7% in Becker implants. We found a significantly higher complication rate with the use of the integrated-valve biodimensional expander than with either the distant port round expander or the Becker expander-implant. Benefits attributed to the integrated valve do not outweigh the complications encountered while using it | ||
| Singh, USA (68) | Cost comparison of immediate one-stage and tissue-expander breast reconstructions after mastectomy in commercially insured patients | 2013 | IV | Cost-Analysis | Immediate | 1,316 breast reconstructions | The data showed a modest, non-significant trend toward fewer return visits after one-stage reconstruction vs. TE reconstruction. Patients with TE reconstructions returned more often for planned returns and planned returns with revisions. Patients with one-stage reconstructions returned more often for unplanned events. The total costs over 18 months were $34,839 and $39,062 for one-stage and TE reconstructions, respectively. The initial reconstruction, including the mastectomy, accounted for 64% of the 18-month costs with one-stage reconstructions and for 54% of the 18-month costs for TE reconstructions. Costs and utilization trended lower over 18 months for one-stage vs. TE reconstructions following post-mastectomy breast reconstructions but did not achieve statistical significance | ||
| Albornoz, USA (4) | A paradigm shift in U.S. Breast reconstruction: increasing implant rates | 2013 | III | Cross-sectional study | The recent significant rise in immediate reconstruction rates in the United States correlates closely to a 203% expansion in implant use. Although the reason for the increase in implant use is multifactorial, changes in mastectomy patterns, such as increased use of bilateral mastectomies, are one important contributor | ||||
| Hershman, USA (8) | Influence of health insurance, hospital factors and physician volume on receipt of immediate post-mastectomy reconstruction in women with invasive and non-invasive breast cancer | 2012 | III | Cross-sectional study | Immediate | 108,992 patients with invasive breast cancer & 14,710 women with DCIS | Increasing age, black race, being married, rural location, and increased comorbidities were associated with decreased rates of immediate breast reconstruction following mastectomy. Immediate in-hospital complication rates were higher for flap reconstruction compared to implant or no reconstruction (15.2%, 4.0%, and 6.1%, respectively, P<0.0001) | ||
| Klit, Denmark (86) | Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain: a nationwide cross-sectional study | 2013 | III | Cross-sectional study | Immediate | 129 patients | 83% response rate | Breast reconstruction with a sub-pectoral implant after tissue expansion does not confer increased prevalence of persistent pain. We found no increased risk of persistent pain in patients having a reconstruction with an implant compared with mastectomy without reconstruction. There was also no difference between patients treated with immediate or DBR | |
| Alderman, USA (71) | Complications in post-mastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study | 2002 | II | Prospective Analysis | Immediate and delayed | 326 patients | 2 years | (I) Immediate reconstructions were associated with significantly higher complication rates than delayed procedures, and (II) procedure type had no significant effect on complication rates although a trend was noted for higher complication rates in implant patients who received radiotherapy | |
| Behranwala, UK (79) | The influence of radiotherapy on capsule formation and aesthetic outcome after IBR using biodimensional anatomical expander implants | 2006 | II | Prospective Analysis | Immediate | 114 patients (136 breast reconstructions) | 4 years | Radiotherapy is associated with a higher capsule formation rate | |
| Clough, France (65) | Prospective evaluation of late cosmetic results following breast reconstruction: I. Implant reconstruction | 2001 | III | Prospective Analysis | Immediate | 360 breast reconstructions | 4.2 years | Deterioration of the cosmetic appearance of implant breast reconstruction was noted in this study. The overall acceptable cosmetic outcome deteriorated from 86% at 2 years after patients completed their reconstruction to only 54% at 5 years. This deterioration was irrespective of the type of implant used | |
| Cowen, USA (33) | Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications | 2010 | II | Prospective Analysis | Immediate | 141 patients | 37 months | Reconstruction failure was analyzed in this study. Three predictors of immediate post-mastectomy breast reconstruction using tissue expanders and implants were identified. These predictors were smoking, T3 or T4 tumors, and axillary lymph node invasion. Also of note, grade 3 or 4 capsular contracture was related to adjuvant hormone therapy, the surgeon, and smoking | |
| Giacalone, France (69) | New concept for IBR for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy IBR vs. DBR: a prospective pilot study | 2010 | II | Prospective Analysis | Immediate and delayed | 104 patients | 4.5- 4.7 years | IBR is a valuable addition to the oncological surgical armamentarium for primary treatment of breast cancer. Our study shows that the feasibility and oncological safety of immediate are comparable to DBR. Total early complications (<30 days) 61.5% (IBR) vs. 56.4% (DBR). Total late complications 30.7% (IBR) vs. 21.7% (DBR) | |
| Krueger, USA (34) | Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy | 2001 | III | Prospective Analysis | Immediate | 81 patients | Mean 31 months | Reconstructive failure was significantly associated with the use of radiotherapy (P=0.005). The observed reconstruction failure rates were 37% for irradiated patients compared with 8% for non-irradiated patients. Despite these differences, our pilot data suggest that both general satisfaction and patient aesthetic satisfaction were not significantly different. In addition, tamoxifen use was associated with a significantly decreased aesthetic satisfaction (P=0.03) | |
| Patani, UK (43) | Oncological safety and patient satisfaction with skin-sparing mastectomy and IBR | 2008 | II | Prospective Analysis | Immediate | 83 patients (93 breast reconstructions) | 34 months | Skin sparing mastectomy with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically adequate for T (is), T1 and T2 tumors without extensive skin involvement. There was no LR after a median follow-up of 34 months (range, 3-79 months). Overall survival was 98.8%. Significant capsule formation, requiring capsulotomy, was observed in 87% of patients who had radiotherapy compared with 13% for those who did not have radiotherapy | |
| Albornoz, USA (5) | Diminishing relative contraindications for immediate breast reconstruction: a multicenter study | 2014 | III | Retrospective Analysis | Breast reconstruction with implant. There was a greater rate increase in implant than autologous reconstructions for both high-risk and low-risk groups. Breast reconstruction increased in high-risk surgical and oncologic patients, suggestive of a diminishing set of relative contraindications. Increased implant use in high-risk patients might be a contributing factor toward the preferential national expansion of prosthetic techniques | ||||
| Albornoz, USA (85) | Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction | 2014 | III | Retrospective Analysis | 3.3 years | Radiotherapy has a negative effect on quality of life and satisfaction with breasts in patients with implant reconstruction compared with non-irradiated patients | |||
| Brown, Canada (53) | Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery | 2005 | III | Retrospective Analysis | Immediate | 32 patients (50 breast reconstructions) | Results in our initial 150 patients have been excellent, with a high degree of patient satisfaction, excellent aesthetic outcomes, and very few implant-related complications. Cohesive gel implants are likely to play an important role in aesthetic and reconstructive breast surgery | ||
| Chang, USA (83) | Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts | 2008 | III | Retrospective Analysis | Immediate and delayed | 706 patient (1,000 breast reconstructions) | 22.2 months | The use of preoperative or postoperative radiation therapy to the reconstructed breast significantly increased the incidence of most implant-associated complications compared with no radiation therapy. An autologous flap, when combined with an implant for breast reconstruction, appears to reduce the incidence of implant-related complications in previously irradiated breasts | |
| Chang, Australia (18) | Experience in dermomyofascial pouch coverage of immediate implants following skin sparing reduction mastectomy | 2013 | III | Retrospective Analysis | Immediate | 6 patients (11 breast reconstructions) | 5-19 months | In our initial experience, SSRM is a safe and effective method of immediate implant-based breast reconstruction | |
| Chew, UK (60) | Becker expander implants: truly a long term single stage reconstruction? | 2010 | III | Retrospective Analysis | Immediate | 68 breast reconstructions | 12.5 years | The use of Becker expanders may be hard to justify in post-mastectomy reconstruction if most patients go on to require removal and replacement of the expander. Reported rates in this study are as high as 94% removal at 10 years | |
| Cordeiro, USA (36) | A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction | 2006 | III | Retrospective Analysis | Immediate and delayed | 315 patients (410 breast reconstructions) | 36.7 months | Tissue expander/implant reconstruction yields well to excellent long-term aesthetic results in the majority of patients. In this study 95% of patients were satisfied with their reconstruction and 88% had a good to excellent aesthetic result. Bilateral reconstructions have higher overall aesthetic grades. Radiation history was a significant predictor of overall cosmesis; however acceptable results are attainable in irradiated patients | |
| Cordeiro, USA (76) | Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients | 2004 | III | Retrospective Analysis | Immediate | 687 patients | The overall success rate for implant reconstruction in irradiated patients was 90% compared to 99% in non-irradiated patients (P<0.000). Of the irradiated patients 80% were noted to have well to excellent aesthetic results, compared to 88% in the non-irradiated group. For the many women who are not candidates for autologous tissue reconstruction or who do not wish to undergo more involved flap surgical procedures, immediate tissue expander/implant reconstruction can be safely recommended even when postoperative irradiation is planned | ||
| Davila, USA (21) | Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: a multi-institutional comparison of short-term complications | 2013 | III | Retrospective Analysis | Immediate | 10,561 patients | 30 days | Immediate one-stage, direct-to-implant, and two-stage tissue expander reconstructions result in low rates of morbidity. One-stage reconstruction suggests a slightly higher complication rate related to prosthesis failure | |
| Handel, USA (58) | A long-term study of outcomes, complications, and patient satisfaction with breast implants | 2006 | II | Retrospective Analysis | N/A | 264 patients (352 breast implant reconstructions) | 37.4 months | Breast implants are associated with a significant rate of local complications and reoperation. There are marked differences in outcomes as a function of implant surface type and surgical indication. Despite relatively frequent complications and reoperations, implant recipients are largely satisfied. Smooth and textured implants had similar contracture rates; polyurethane foam-covered implants had a reduced risk of contracture persisting for at least 10 years after implantation | |
| Hardwicke, UK (51) | A retrospective audit of Novagold ‘hydrogel’ breast implants | 2007 | III | Retrospective Analysis | N/A | 250 patients | Of the 250 patients who underwent implantation of these implants 44% of cases needed further surgery for complications. Capsular contracture requiring surgical intervention occurred in 32%. Symptomatic ruptures occurred in 10.5%. From comparison with published data, the incidence of capsular contracture is comparable, but the occurrence of rupture is almost twice that of saline-filled implants. The results of this study show that this composition of implant poses potential risks, which should be considered by manufacturers in the future. We advise removal of symptomatic implants, as rupture is likely to have occurred | ||
| Jónsdóttir, Iceland (90) | Results of immediate breast reconstructions at Landspitali-The National University Hospital of Iceland, in 2008-2010 | 2012 | III | Retrospective Analysis | Immediate and delayed | 157 breast reconstructions | As a result of the establishment of an oncoplastic breast surgical service at Landspítali, the rates of immediate breast reconstruction have increased significantly (from 5% to 31%). The rates of autologous flap reconstructions were significantly higher than in this study (63% vs. 26%) | ||
| Kim, Korea (16) | Short-term outcomes of IBR using an implant or tissue expander after mastectomy in breast cancer patients | 2014 | III | Retrospective Analysis | Immediate | 63 patients | 22.4 months | 63 patients had immediate reconstruction with expanders or implants. Major complications included nipple areolar complex (NAC) necrosis and implant removal in 11.1% of the patients. 3 patients had their implant removed due to severe infection, leakage and dissatisfaction. 84.1% of patients were satisfied with the overall result and 77.8% were satisfied with the cosmesis of their reconstructions | |
| Lentz, USA (74) | Radiation therapy and expander-implant breast reconstruction: an analysis of timing and comparison of complications | 2013 | III | Retrospective Analysis | Immediate | 55 patients (56 breast reconstructions) | 27.3 months | No significance was found in overall complication rates or reconstruction failure rate between cohorts of patients who had exchange prior to radiotherapy compared to after radiotherapy. Nor was a significance found between early exchanges in comparison to late exchange following radiotherapy. Trends suggest a higher rate of infection in patients who underwent exchange earlier (30% vs. 14.29%, P=0.422) and a higher rate of capsular contracture in patients who underwent exchange later (5% vs. 21.43%, P=0.283); however, statistical significance was not reached. Our findings suggest that neither the sequencing nor timing of expander-implant exchange in the setting of post-mastectomy radiotherapy (PMRT) affects overall complication or reconstruction failure rate. However, the timing of exchange may impact the type of complication encountered | |
| Losken, USA (81) | Factors that influence the completion of breast reconstruction | 2004 | III | Retrospective Analysis | Immediate and delayed | 888 patients (1038 breast reconstructions) | Delayed reconstructions had a higher number of secondary procedures compared to immediate reconstructions. TRAM flap reconstructions tended to have more secondary procedures than implant or latissimus dorsa reconstructions. Radiation therapy is also associated with an increased number of secondary procedures. Autologous tissue reconstructions in general required more secondary procedures-hypothesized in this study to be partly due to donor site revisions | ||
| Macadam, Canada (47) | Patient satisfaction and health-related quality of life following breast reconstruction: patient-reported outcomes among saline and silicone implant recipients | 2010 | III | Retrospective Analysis | N/A | 143 breast reconstructions | 58% response rate | This study has shown higher satisfaction with breast reconstruction in silicone gel implant recipients compared with saline recipients using the BREAST-Q. There was no difference in overall global health status between the 2 patient groups. Silicone recipients had higher overall physical function, and saline recipients had higher systemic side effects | |
| Macadam, Canada (52) | Patient-reported satisfaction and health-related quality of life following breast reconstruction: a comparison of shaped cohesive gel and round cohesive gel implant recipients | 2013 | III | Retrospective Analysis | N/A | 128 patients | 75% response rate | There was no difference appreciable between round and shaped implants on any scale including overall satisfaction with breast and outcome. Shaped implants were significantly firmer than round. There was no difference in rippling of the implant between the 2 types | |
| McCarthy, USA (48) | Patient satisfaction with postmastectomy breast reconstruction: a comparison of saline and silicone implants | 2010 | III | Retrospective Analysis | N/A | 482 patients | 72% response rate | Patients’ satisfaction with their breasts was significantly higher in patients with silicone implants (P=0.016) compared to saline implants. The receipt of post-mastectomy radiotherapy was found to have a significant, negative effect on breast satisfaction (P<0.000) in both silicone and saline implant recipients. In addition, for women who received either silicone or saline implants, satisfaction diminished over time (P=0.017) |
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| Parsa, USA (78) | Selection criteria for expander/implant breast reconstruction following radiation therapy | 2009 | III | Retrospective Analysis | Delayed | 27 patients | Irradiated chest walls with moderate skin changes and absent induration have aesthetic outcomes comparable to the non-irradiated chest walls (P>0.50). In contrast, patients who develop induration or severe post-radiation skin changes have a greater rate of modified Baker class IV capsular contracture and poor results that range from 75% to 100% of reconstructed breasts. A history of chest wall radiation should not itself exclude patients from receiving expander/implant reconstruction. Patients who develop neither severe skin changes nor induration may still be considered for prostheses | ||
| Pinsolle, France (41) | Complications analysis of 266 IBRs | 2006 | III | Retrospective Analysis | Immediate | 249 patients (266 breast reconstructions) | 7 years | The complication rate for IBR with implant alone (39%) was lower than that associated with latissimus dorsi with or without implant (51%), but the difference was not significant. The risk factors for complications were smoking (skin necrosis), obesity (infection), and radiotherapy. Capsular contractures were more frequent when implants were used alone (25%) as well as when used along with a flap (6.8%). In our opinion, latissimus dorsa myocutaneous flap with or without an implant is a good compromise between complication risk and necessity of good cosmetic result requirement. These results have led us to delay or contraindicate reconstruction in the case of obesity or heavy smoking. In the case of probable post-operative radiotherapy, we prefer to delay the breast reconstruction. | |
| Roostaeian, USA (17) | Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction | 2012 | III | Retrospective Analysis | Immediate | 35 patients (62 breast reconstructions) | 14 months | The overall complication rates of immediate implant-based reconstructions and immediate tissue expander reconstructions were similar, and the need for revision surgery was also similar. Mean final implant volume did not differ between the two groups. However, mean number of office visits/time to nipple reconstruction was significantly reduced (P<0.001) in the implant group. Aesthetic evaluation revealed no significant differences. In the appropriately selected patient, it is a safe option that provides similar outcomes in less time compared with staged expander-based reconstruction | |
| Singh, USA (38) | Immediate 1-stage vs. tissue expander post-mastectomy implant breast reconstructions: a retrospective real-world comparison over 18 months | 2012 | III | Retrospective Analysis | Immediate | 1,316 breast reconstructions | Overall survival in this study was 100%. The incidence of flap necrosis/loss, implant loss, wound infection, or hematoma requiring surgical evacuation was 0%, 0%, 0%, and 0%, respectively. Capsule formation requiring capsulotomy was observed in 3 of 21 patients (14%). The median patient satisfaction score was 10 (range, 6-10). The results show that surgeons in the United States achieved substantially similar results in immediate post-mastectomy implant breast reconstructions with 1-stage and TE approaches in terms of patient complications and returns for reconstruction-related services over 18 months. As evolving mastectomy techniques make 1-stage implant reconstructions more attractive, we hope these findings will motivate researchers to compare the approaches in more strictly controlled clinical studies | ||
| Spear, USA (50) | Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications | 2000 | III | Retrospective Analysis | Immediate and delayed | 40 patients | Using a scoring system for judging cosmetic results of breast reconstructions 40 patients were reviewed by a panel. Cosmesis was given a score by the judges between 1.4 and 4.0. Those patients who had undergone radiation therapy during expansion scored from 1.4 to 3.85 (mean, 2.925). Those radiated after reconstruction ranged from 1.75 to 4.0 (mean, 3.25). The control group was scored between 2.125 and 3.875 (mean, 3.28). The increasing use of radiation after mastectomy has important implications for breast reconstruction. The possibility for radiation should be thoroughly investigated and anticipated preoperatively before IBR. Patients with invasive disease, particularly with large tumors or palpable axillary lymph nodes, are especially likely to be encouraged to undergo post-mastectomy radiation therapy | ||
| Sullivan, USA (39) | True incidence of all complications following immediate and DBR | 2008 | III | Retrospective Analysis | Immediate and delayed | 240 patients (334 breast reconstructions) | Autologous reconstruction can be performed immediately or delayed, with optimal aesthetic outcome and low flap loss risk. However, the overall complication rate and capsular contracture incidence following immediate tissue expander/implant reconstruction was much higher than when performed delayed. Capsular contracture was a significantly more common late complication following immediate (40.4%) vs. delayed (17.0%) reconstruction (P<0.001). Thus, tissue expander placement at the time of mastectomy may not necessarily save the patient an extra operation and may compromise the final aesthetic outcome | ||
| Wong, USA (82) | Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy | 2008 | III | Retrospective Analysis | Immediate | 62 patients | 10-13 months | Major corrective surgery was undertaken by 16% of total patients studied following radiotherapy. This incorporated 9% of non-implant based reconstructions compared to 40% of implant based reconstructions. Patients who undergo immediate reconstruction after mastectomy using an implant followed by radiation have a high rate of subsequent major corrective surgery. The difference between the implant and non-implant groups is significant in early follow-up. Patients considering implant reconstruction followed by radiotherapy should be made aware of this risk |
. IBR, Immediate breast reconstruction; DBR, delayed breast reconstruction; LR, local recurrence; TRAM, transverse rectus abdominis musculocutaneous; ADM, acellular dermal matrix; DCIS, ductal carcinoma in situ; SSRM, skin sparing reduction mastectomy.