Determining the outcomes of post mastectomy radiation therapy delivered to the definitive implant in patients undergoing one and two stage implant based breast reconstruction: A systematic review and meta-analysis

Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Louise J. Magill, Francis P. Robertson, Gavin Jell, Ash Mosahebi, Mohammad Keshtgar
BackgroundPost mastectomy radiation therapy is known to increase complication rate and implant loss in implant based breast reconstruction. The purpose of this study was to systematically review the literature regarding outcome of PMRT delivered to the permanent/definitive implant.MethodsSystematic review and meta-analysis of studies involving immediate implant based reconstruction and post mastectomy radiation therapy (PMRT) when delivered to the permanent implant.ResultsSeven studies included 2921 patients (520 PMRT, 2401 control). PMRT was associated with significant increase in capsular contracture (7 studies, 2529 patients, 494 PMRT, 2035 control, OR 10.21 95% C.I 3.74 to 27.89, p<0.00001). In addition, PMRT was associated with a significant increase in revisional surgery (7 studies, 2921 patients, 520 PMRT, 2401 control, OR 2.18 95% C.I 1.33 to 3.57, p=0.002) and reconstructive failure (6 studies, 2814 patients, 496 PMRT, 2318 control, OR 2.52 95% C.I 1.48 to 4.29, p+o.ooo7). Moreover it was associated with a significant reduction in patient satisfaction (4 studies, 468 patients, 138 PMRT, 294 control, OR 0.29 95% C.I 0.15 to 0.57, p=0.0003) and cosmetic outcome (4 studies, 1317 patients, 238 PMRT, 1009 control, OR 28 95% C.I. 0.11 to 0.67, p=0.005.)ConclusionsThis meta-analysis demonstrates that within the first five years post implant-based reconstruction for those patients who receive PMRT, the rates of adverse events is increased and there is significant reduction in patient satisfaction and cosmetic outcome.



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