Iwahira Yoshiko, Nakagami Gojiro, Morita Kojiro, Sanada Hiromi
Breast Surgery Clinic, Tokyo, Japan.
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Medicine (Baltimore). 2025 Feb 7;104(6):e41438. doi: 10.1097/MD.0000000000041438.
Breast reconstruction using tissue expanders and silicone implants has become increasingly popular in Japan since health insurance began covering the procedure in 2013. Radiotherapy after mastectomy is recommended for certain patients and has been identified as a major risk factor for capsular contractures. However, the effect of radiation therapy timing on the development of capsular contracture has not yet been thoroughly studied. This study aimed to evaluate the effects of radiation therapy timing on the development of capsular contractures in patients who underwent implant-based breast reconstruction performed by a single expert plastic surgeon. This retrospective cohort study included 341 patients undergoing implant-based breast reconstruction and irradiation between April 2003 and March 2019. Patients were categorized based on radiation and operation types. Variables included postirradiation skin condition, implant mobility, and expander placement position. The outcome measure was the development of capsular contracture, assessed using the Baker Classification. Of 340 patients, 43 developed severe capsular contracture (Baker classification Grade III) within 2 years (cumulative incidence, 12.6 %). No significant relationship was found between the radiation or operation type and capsular contracture. Instead, postirradiation skin redness, implant mobility, skin pinchability after 1 year, and expander positioning were found to be significant factors affecting capsular contracture development. The timing of radiation therapy was not a determinant of capsular contracture development. Factors such as postirradiation skin inflammation, implant mobility, ability to pinch the skin, and expander position play pivotal roles in determining capsular contracture development.
自2013年医疗保险开始覆盖该手术以来，使用组织扩张器和硅胶植入物进行乳房重建在日本越来越普遍。乳房切除术后放疗适用于某些患者，并且已被确定为包膜挛缩的主要危险因素。然而，放疗时机对包膜挛缩发展的影响尚未得到充分研究。本研究旨在评估放疗时机对由一位专业整形外科医生进行的基于植入物的乳房重建患者包膜挛缩发展的影响。这项回顾性队列研究纳入了2003年4月至2019年3月期间接受基于植入物的乳房重建和放疗的341例患者。患者根据放疗和手术类型进行分类。变量包括放疗后皮肤状况、植入物活动度和扩张器放置位置。结局指标是包膜挛缩的发展，采用贝克分类法进行评估。在340例患者中，43例在2年内出现严重包膜挛缩（贝克分类III级）（累积发病率为12.6%）。未发现放疗或手术类型与包膜挛缩之间存在显著关系。相反，放疗后皮肤发红、植入物活动度、1年后皮肤可捏性和扩张器位置是影响包膜挛缩发展的重要因素。放疗时机不是包膜挛缩发展的决定因素。放疗后皮肤炎症、植入物活动度、捏皮肤的能力和扩张器位置等因素在决定包膜挛缩发展中起关键作用。
