From the Division of Plastic Surgery, Emory University School of Medicine, Atlanta GA.
Ann Plast Surg. 2024 Apr 1;92(4):379-382. doi: 10.1097/SAP.0000000000003827.
Radiation therapy can adversely affect outcomes of implant-based breast reconstruction, potentially complicating procedures like nipple-sparing mastectomy (NSM), which is increasingly popular in breast cancer management. This study aims to evaluate the impact of radiation on nipple symmetry in patients undergoing bilateral NSM with implant-based reconstruction.
We conducted a retrospective analysis using data from an Emory University review board-approved database. This encompassed bilateral NSMs coupled with immediate implant-based reconstructions. The BCCT.core software was employed to objectively measure nipple asymmetry preoperatively and postoperatively. Metrics, such as Breast Retraction Assessment values, upper nipple retraction, lower breast contour, and nipple to midline (NML) discrepancies were quantified. The study included 80 patients with a minimum of 1 year of follow-up; among them, 15 received radiation therapy (RT) while 65 did not.
The reconstructions were divided into tissue expander, used in 39 cases (48.8%), and direct-to-implant (DTI), employed in 41 cases (51.2%). The DTIs were further categorized based on the location of the implant: 22 subpectoral and 19 prepectoral. Radiation was applied to 15 breasts, distributed among prepectoral DTI (4), subpectoral DTI (6), and tissue expander (5). Breast Retraction Assessment scores significantly differed between the nonirradiated and irradiated groups (1.49 vs 2.64, P < 0.0004). Nipple to midline differences and Upper Nipple Retraction also significantly varied postradiation, especially when comparing subpectoral and prepectoral implant placements.
Radiation therapy has a detrimental effect on nipple symmetry after bilateral NSM and implant-based reconstruction, with variations seen regardless of the implant's placement or the reconstructive technique utilized. Specifically, subpectoral reconstructions irradiated were prone to lateral nipple displacement, likely related to radiation-induced pectoralis muscle changes, while prepectoral irradiated reconstructions tended to have increased vertical displacement. These insights are crucial for patient education and surgical planning in the context of radiation and breast reconstruction.
放射治疗可能会对基于植入物的乳房重建的结果产生不利影响，从而使乳头保留乳房切除术（NSM）等程序复杂化，而 NSM 在乳腺癌管理中越来越受欢迎。本研究旨在评估放射治疗对接受双侧 NSM 联合基于植入物重建的患者乳头对称性的影响。
我们使用经埃默里大学审查委员会批准的数据库中的数据进行了回顾性分析。这包括双侧 NSM 联合即刻基于植入物的重建。使用 BCCT.core 软件在术前和术后客观地测量乳头不对称。量化了乳房退缩评估值、上乳头回缩、下乳房轮廓和乳头到中线（NML）差异等指标。该研究纳入了 80 例至少随访 1 年的患者；其中 15 例接受放射治疗（RT），65 例未接受。
重建分为使用组织扩张器的 39 例（48.8%）和直接植入物（DTI）的 41 例（51.2%）。DTI 进一步根据植入物的位置分类：22 例胸肌下和 19 例胸肌前。15 个乳房接受了放射治疗，分布在胸肌前 DTI（4 例）、胸肌下 DTI（6 例）和组织扩张器（5 例）。未接受放射治疗和接受放射治疗的两组间乳房退缩评估评分有显著差异（1.49 与 2.64，P<0.0004）。乳头到中线的差异和上乳头回缩在放射后也有显著变化，尤其是比较胸肌下和胸肌前植入物放置时。
放射治疗对双侧 NSM 和基于植入物的重建后的乳头对称性有不利影响，无论植入物的位置或使用的重建技术如何，都有差异。具体来说，接受放射治疗的胸肌下重建更容易出现侧向乳头移位，可能与放射诱导的胸大肌变化有关，而接受放射治疗的胸肌前重建则倾向于出现更大的垂直移位。这些发现对于放射治疗和乳房重建背景下的患者教育和手术计划至关重要。
