Abstract: Implant-Based Breast Reconstruction and the Timing of Adjuvant Radiotherapy: A Systematic Review and Meta-Analysis of Surgical Outcomes

Abstract

INTRODUCTION: Implant-based breast reconstruction is the most common type of reconstruction following post-mastectomy radiation therapy (PMRT). The impact of the timing of PMRT to a tissue expander or permanent implant is not well understood. The purpose of this systematic review was to evaluate outcomes in implant-based reconstruction and the timing of PMRT. METHODS: A review of the English literature in the PubMed/MEDLINE database (2000–2016) was performed to identify all manuscripts on implant-based breast reconstruction and PMRT. Cases from each study were grouped by PMRT to a tissue expander or PMRT to a permanent implant. Outcomes of interest included reconstructive failure and capsular contracture as overall rates and associations were pooled. Effect sizes (z-values), risk ratios (RRs), and heterogeneity scores (I2) were calculated on meta-analysis. RESULTS: There were 20 studies meeting inclusion criteria with 2,348 patients identified. Pooled analysis revealed an overall rate of reconstructive failure of 17.6% and Baker grade III / IV capsular contracture of 37.5%. PMRT applied to tissue expanders resulted in higher rates of reconstructive failure compared to PMRT applied to permanent silicone implants (20% vs. 13.4%, RR = 2.33, p = 0.0083, 95% CI 1.24 – 4.35), but lower rates of capsular contracture (24.5% vs. 49.4%, RR = 0.53, p = 0.083, 95% CI 0.26 – 1.09). CONCLUSION: Regardless of timing, PMRT applied to implant-based breast reconstruction was associated with high risk of reconstructive failure and capsular contracture. Surgeons should consider alternative strategies, such as autologous tissue reconstructions, in patients requiring PMRT.