Saksornchai Kitwadee, Ganoksil Peeraya, Rongkavilit Surasake, Suwajo Poonpissamai
Division of Therapeutic Radiology and Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Plastic and Reconstruction Surgery, Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Gland Surg. 2023 Aug 30;12(8):1050-1059. doi: 10.21037/gs-23-61. Epub 2023 Aug 23.
While the trend towards immediate breast reconstruction is growing, data on the long-term outcomes of patients receiving irradiation afterwards are scarce. We retrospectively reviewed the long-term complication rates in patients who received adjuvant radiation therapy after immediate breast reconstruction in our institution.
We included 134 patients with breast cancer who underwent single-stage immediate breast reconstruction between January 2008 and December 2018. Sixty-eight patients received adjuvant irradiation and 66 patients did not. Autologous tissue, implant-based, and combined (implant and flap) reconstruction were performed in 40, 55, and 39 patients, respectively. Flap and implant complications data were collected. Baker's classification was used to assess capsular contracture.
The average follow-up was 47 months. Both groups had similar baseline clinical characteristics and treatments received. The irradiated-group had a higher incidence of adjuvant chemotherapy (P<0.01) and a significantly higher rate of grade III/IV capsular contracture (42.1% 26.9%; P=0.004) than that of the non-irradiated group. The median time to the development of capsular contracture was 37 41 months in the irradiated the non-irradiated group, respectively. There were no differences in the incidence of flap complications between both groups. The only significant risk factor associated with grade III/IV capsular contracture was adjuvant post-mastectomy irradiation. The irradiated group had a higher risk of developing grade III/IV capsular contracture [odds ratio (OR), 4.35; 95% confidence interval (CI): 1.55-12.27].
Postmastectomy radiotherapy adversely affects implant-based immediate one-stage reconstruction by increasing the rate of moderate to severe capsular contracture but is not associated with flap complications.
尽管即刻乳房重建的趋势日益增长，但关于此类患者术后接受放疗的长期结局的数据却很匮乏。我们回顾性分析了在我院接受即刻乳房重建后辅助放疗患者的长期并发症发生率。
我们纳入了2008年1月至2018年12月期间接受单阶段即刻乳房重建的134例乳腺癌患者。68例患者接受了辅助放疗，66例未接受。分别有40例、55例和39例患者接受了自体组织重建、假体植入重建和联合（假体和皮瓣）重建。收集皮瓣和假体并发症数据。采用贝克分类法评估包膜挛缩。
平均随访时间为47个月。两组患者的基线临床特征和接受的治疗相似。放疗组辅助化疗的发生率更高（P<0.01），III/IV级包膜挛缩的发生率显著高于未放疗组（42.1%对26.9%；P=0.004）。放疗组和未放疗组包膜挛缩发生的中位时间分别为37个月和41个月。两组皮瓣并发症的发生率无差异。与III/IV级包膜挛缩相关的唯一显著危险因素是乳房切除术后辅助放疗。放疗组发生III/IV级包膜挛缩的风险更高[比值比（OR），4.35；95%置信区间（CI）：1.55-12.27]。
乳房切除术后放疗会增加中重度包膜挛缩的发生率，从而对基于假体的即刻单阶段重建产生不利影响，但与皮瓣并发症无关。
