Implants For Reconstruction Research Articles

Impact of Age, Obesity and Smoking on Patient Satisfaction with Breast Implant Surgery - A Unicentric Analysis of 318 Implant Reconstructions after Mastectomy.

Aim: Breast reconstruction has become increasingly important for the body image of women with breast cancer. We conducted a study to investigate how patient characteristics correlate with surgical outcome after breast reconstruction with implant after mastectomy and to identify risk factors which could facilitate patient selection for reconstruction. Patients and Methods: For this case cohort analysis (n = 257 patients with 318 heterologous reconstructions), we analyzed BMI, smoking, pre-existing disease, chemotherapy and radiotherapy, one-stage/two-stage reconstruction, immediate/delayed reconstruction, antibiotic therapy and complications, partner interaction and adherence to the decision for reconstruction using a customized questionnaire. Results: 257 patients with 318 implant reconstructions (196 unilateral, 61 bilateral) were eligible for inclusion in the study. Median follow-up time was 3.1 years (range: 1 month to 10 years). Response rate to the questionnaire was 71.8 %. Median age was 49 years (range 24-79 years), median BMI was 22.44 (range 16.33-40.09). A BMI > 30 was inversely correlated with positive self-image (p = 0.004), and implant loss/rotation was more frequent in this group (p < 0.05). Smoking > 10 cigarettes/day had a negative impact on surgical outcome. A positive self-image had a positive impact on partner interaction (p < 0.001) and was correlated with a lower perception of pain. Aesthetic results did not vary with age (p = 0.054). Titanized polypropylene meshes were used to protect against implant rotation (p = 0.034). Rates of capsular fibrosis were low in our cohort (< 10 %), and implant loss rate was less than 2 %. Conclusions: This study offers a differentiated approach for the pre-surgical counselling of patients and shows that patients up to 80 years of age are highly satisfied with implant reconstruction. A high BMI and smoking > 10 cigarettes/day are unfavorable preconditions for implant reconstruction. The use of prophylactic antibiotics was confirmed as beneficial for surgical outcome. A positive self-image after reconstruction strongly influences partner interaction.

SU‐E‐T‐209: Comparison of Plan Quality Between Arm Avoidance (AA) Vs. Non Arm Avoidance VMAT Planning Techniques for Breast Cancer Patients with Bilateral Implant Reconstructions Receiving Postmastectomy Radiation

Purpose:Breast cancer patients with bilateral implant reconstructions who require postmastectomy radiotherapy can pose unique treatment planning challenges. The use of VMAT may provide advantages over conventional tangent or multi‐beam IMRT techniques. Moreover, daily setup uncertainly of the arm position, however, could have significant impact on accurate dose delivery. This study compares the plan qualities between non‐AA and AA VMAT techniques.Methods:Three breast cancer patients receiving left chest wall and regional nodal irradiation with bilateral implant reconstructions were studied. PTV included chest wall and IMNs (PTV‐CW), and supraclavicular and axillary lymph nodes (PTV‐SCV). For each patient, one non‐AA VMAT plan (VMAT‐S) with 4 partial arcs encompassing the ipsilateral arm and three AA VMAT plans where no arcs were entering or existing through the ipsilateral arm were generated. VMAT‐AA1 uses 2 arcs for PTV‐CW and 2 arcs for PTV‐SCV. VMAT‐AA2 used two static fields for PTV‐SCV with 2 arcs for PTV‐CW. VMAT‐AA3 used 2 narrow arcs for PTV‐CW and 2 long arcs for all PTVs. Prescription dose (PD) was 50 Gy (25 fractions). All plans were normalized to have 95% of PD to 95 % of PTV. PTV dose inhomogeneity and dose to the heart, left lung, right thyroid dose and left humerus were evaluated.Results:For VMAT‐S, VMAT‐AA1, VMAT‐AA2 and VMAT‐AA3, respectively, the average and standard deviation (in Gy unless specified otherwise) of PTV D05 are 54.7±0.9, 55.9±0.4, 56.7±0.7 and 55.7±0.4; mean Heart dose: 7.1±0.7, 7.2±0.8, 7.3±0.9 and 6.9±1.0; left lung V20Gy (in %): 28.1±1.0, 28.8+2.2, 32.2±4.1 and 27.8±2.0; mean right thyroid dose: 8.1±0.6, 5.1±2.1, 2.1±0.4 and 5.0±2.0; mean left humerus dose: 20.0±4.4,15.6±4.4, 15.2±8.2 and 15.3±4.6.Conclusion:AA VMAT can produce acceptable clinical plans while eliminating dosimetric impact related to arm setup uncertainty. These data require validation in larger planning studies prior to routine clinical implantation.

P153. Use of acellular dermal matrix (ADM) in nipple reconstruction following breast reconstruction; the ‘central-pillar technique’

P153. Use of acellular dermal matrix (ADM) in nipple reconstruction following breast reconstruction; the ‘central-pillar technique’

P152. Is lipomodelling after breast cancer safe?

P152. Is lipomodelling after breast cancer safe?

Abstract P2-14-09: Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy

Abstract Approximately 30-40% of women are not offered immediate breast reconstruction because the possibility of post-mastectomy radiotherapy (PMRT) is unknown at the time of mastectomy. Breast reconstruction may be delayed until final pathology is available and need for radiotherapy established. Surgical literature is replete with studies of varying quality, reporting complication rates for a range of reconstructive procedures, highlighting the need for surgical trials of reconstructive techniques in women at risk of PMRT. Decisions for these patients are complex, involving multiple clinicians including surgeons and oncologists. To inform a surgical trial design, we aimed to determine current UK surgical practice and gain an understanding of the drivers behind decision-making. Methods: A questionnaire, validated in a pilot population, was posted to Consultant members of the Association of Breast Surgery (UK). We collected data on current practice in conducting Delayed, Immediate and Delayed-immediate reconstructive surgery. We collated data on type and volume of procedure performed and factors affecting decision-making including delay to adjuvant treatment, risk of complications, perception of patients’ quality of life (QoL) and aesthetic satisfaction. Results: Of 355 surgeons, 130(37%) responded. Of these, 77% felt the current evidence base was not adequate to guide surgical decisions and 80% felt a need for further trials to guide best treatment. Despite a lack of scientific evidence demonstrating a difference in cosmesis or QoL between Immediate and Delayed reconstruction, 85% felt there is not equivalent cosmesis and 71% felt there is not equivalent QoL between the two groups. There is considerable heterogeneity in reconstructive approach to patients at risk of PMRT (Table 1). Delayed reconstruction remains the most popular option, being regularly used by 94% of surgeons despite only 34% of surgeons believing the majority of patients are satisfied with the approach. Significantly fewer surgeons perform Immediate implant based reconstruction (with or without ADM) than Delayed (p&amp;lt;0.01). Implant reconstruction is performed by 71% of surgeons in patients at risk of PMRT, but only 44% of surgeons felt patients were happy with the final results. Table 1 No. of responses NeverSometimesOftenAlwaysDelayed5505119Immediate implant584181Immediate ADM+Implant45491452-stage (delayed-immediate) Expander to permanent reconstruction2855335Immediate Autologous2959227 The three most important drivers in making a reconstructive choice were 1. Effect of PMRT on the cosmetic result 2. Minimising risk of complications and avoiding delay to adjuvant treatment 3. Pre-operative uncertainty over the need for PMRT. Conclusions: Surgeons employ a variety of approaches to reconstruction in the face of PMRT, the most common approach being delayed reconstruction. Decision-making is based upon individual surgeon’s perception of risks including likely delay to adjuvant therapy and effect of PMRT on the reconstruction. Drivers appeared to be more surgeon-centred rather than patient-based. There is awareness of a lack of evidence to support decision-making and the need for high quality studies. Randomised clinical trials are needed to provide an evidence base for outcomes. Citation Format: James R Harvey, Nigel J Bundred, Cliona C Kirwan, Ashu Gandhi, Paula J Duxbury. Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-14-09.

Randomized Controlled Clinical Trial of All-Ceramic Single Tooth Implant Reconstructions Using Modified Zirconia Abutments: Radiographic and Prosthetic Results at 1 Year of Loading.

This study aims to test whether or not veneering of the submucosal part of zirconia abutments with pink dental ceramic affects radiographic and technical outcomes of implant-supported single crowns (ISSC). Single tooth implants were randomly restored with either pink-veneered zirconia abutments (test; n = 10) or non-veneered zirconia abutments (control group; n = 10) and all-ceramic crowns. At baseline (crown insertion), and 6- and 12-month radiographic and technical evaluations were performed including standardized x-rays and modified United States Public Health Service criteria (technical). Survival and complication rates were assessed for implants and restorations. Robust linear mixed model analysis was performed to investigate the effect of group and time-point on radiographic outcomes. At 1 year, the survival rate for implants was 100% and 95% for ISSC. Most of the implants were placed subcrestally. Therefore, mean marginal bone levels decreased in both groups between implant insertion and baseline (p < .05), but then remained stable up to 1 year (test: 0.15 mm ± 0.42 mm; control 0.23 mm ± 0.63 mm) (p > .005). At 6 months, one minor chipping occurred in the test group. At 1 year, three crowns (control) exhibited occlusal roughness. In addition, one abutment fracture occurred (test). The differences between test and control group were not statistically significantly different for any of the evaluated outcome measures (p > .05). Veneering of the submucosal part of zirconia abutments did not affect biological and technical outcomes of ISSCs. Technical complications of the reconstructions, however, were frequent, resulting in a rate of 75% of the crowns being complication free.

Implants in Periodontally Compromised Patients: Unveiling the misconception

Implant reconstruction in periodontal patients has been shown to be a successful and predictable treatment option for the replacement of missing teeth due to tooth loss resulting from destructive periodontal disease. Some long-term studies have demonstrated a higher risk of peri-implantitis in this group of patients. Therefore, stabilizing the periodontal condition before implant installation is mandatory, and providing long-term supportive periodontal therapy is of utmost importance. This review briefs such options with emphasis on how the face of Periodontology has changed in the last 20 years of its practice.

Dental Implant Reconstruction of Fibular Free Flaps After Maxillofacial Oncologic Resection

Dental Implant Reconstruction of Fibular Free Flaps After Maxillofacial Oncologic Resection

Immediate Permanent Implant Reconstruction Following Mastectomy With Capsule Preservation in Patients With Prior Augmentation Mammoplasty

Prior breast augmentation in patients desiring post-mastectomy reconstruction provides a unique opportunity for capsular preservation and immediate, single-step implant reconstruction. We report a case series of a single-surgeon experience with immediate implant reconstruction after skin-sparing mastectomy in patients with prior subpectoral augmentation. Final implant volumes, complications, and outcomes were examined. Twenty patients (15 bilateral, total 35 breasts) were included. Eighteen (90%) patients were treated for cancer. Mean augmentation-to-reconstruction interval was 9 years (range, 3-19 years). Mean patient age was 45.1 years (range, 37-64 years). Eight patients (40%) received postoperative chemotherapy and two (10%) radiation. Mean mastectomy weight was 321 g. Mean weight of the implants removed was 346 g. Mean volume of new implants was 487 mL. All patients underwent capsulotomy (100% superior, 85% medial, 30% inferior, 5% lateral). Mean operative time was less than 1 hour for bilateral reconstruction. With average follow-up of 25.6 months, 2 patients were re-operated on for asymmetry (implant malposition, synmastia). Thirty-day complications included 1 implant loss due to infection, 1 drain placement with implant salvage, 1 hematoma requiring evacuation, and 1 cellulitis treated with antibiotics. There were no late complications and no capsular contractures. None have required further oncologic surgery. No cancer recurrences have been detected. In patients who desire prosthetic reconstruction similar to their original submuscular augmentation, capsule preservation and implant replacement with a larger prosthetic inserted within the old capsule is safe, fast, and aesthetically pleasing without compromising oncologic principles.

All-Ceramic Single-Tooth Implant Reconstructions Using Modified Zirconia Abutments: A Prospective Randomized Controlled Clinical Trial of the Effect of Pink Veneering Ceramic on the Esthetic Outcomes

The aim of this study was to test whether veneering of the submucosal part of zirconia abutments using pink veneering ceramic positively influences the color of the peri-implant mucosa. Single-tooth implants were restored with either white zirconia abutments (control group) or pink-veneered zirconia abutments and all-ceramic crowns. Esthetic outcome measurements included a spectrophotometric evaluation of the peri-implant mucosal color. Test and control groups induced a visible discoloration of the peri-implant mucosa after the insertion of the abutments and following cementation of the crowns compared to natural teeth. The calculated color differences were above the clinically visible threshold value and were more favorable for the control group, although not statistically significant. It is concluded that veneering of zirconia abutments with pink veneering ceramic failed to positively influence the esthetic outcome, mostly due to a decrease of the brightness compared with the control group.

Surgical Treatment of Nipple Malposition in Nipple Sparing Mastectomy Implant Reconstruction

Surgical Treatment of Nipple Malposition in Nipple Sparing Mastectomy Implant Reconstruction

Antibiotic Selection for the Treatment of Infectious Complications of Implant-Based Breast Reconstruction

Infection requiring explantation remains the most devastating complication associated with implant-based breast reconstruction. There are many treatment algorithms to prevent reconstructive failure in face of infection using both oral and intravenous antibiotics. In the absence of patient-specific culture data, antibiotic selection is generally directed toward broad-spectrum coverage based on historical data. We hypothesize that reviewing our institution's microbiology data obtained from explanted implant-based breast reconstructions would provide a rational basis for antibiotic selection in the future. A retrospective review of 902 consecutive immediate implant-based breast reconstructions at a single institution from November 2007 to May 2011 was conducted. Implant reconstructions requiring explantation or drainage by interventional radiology were identified. Patient demographics, implant characteristics, presence of skin necrosis, microbiological data, and outcomes were reviewed. Forty-three (4.76%) implant reconstructions requiring explantation or drainage by interventional radiology met the inclusion criteria for this study. Five patients (11.6%) had round, smooth silicone implants, and 36 (88.4%) had textured tissue expanders. Twenty-six implants were explanted because of infection; 3, because of exposure from skin necrosis; and 11, because of the combination of flap necrosis and infection; and 1, secondarily because of cancer invasion into the skin. Reconstruction was salvaged in 21 breasts (51.2%): 12 (57.1%) by implant reconstruction, 5 (23.8%) by pedicled latissimus dorsi flaps, and 4 (19.1%) with a microvascular free flap. Thirty explants had microbiology data available. The most common organism isolated was Staphylococcus epidermidis (10), followed by methicillin-sensitive Staphylococcus aureus (5), Serratia marcescens (5), Pseudomonas aeruginosa (4), enterococcus (3), Escherichia coli (2), Enterobacter (2), group B streptococcus (1), and Morganella morganii (1). Forty percent of the organisms were resistant to cefazolin; however, 86% were sensitive to gentamicin, 80% were sensitive to Levaquin, and 63% were sensitive to ciprofloxacin. Infection associated with implant-based breast reconstructions continues to threaten explantation and reconstructive failure. Based on our microbiological data, initial cellulitis amenable to oral antibiotics should be treated with oral fluoroquinolones as a first-line treatment. If this regimen fails, intravenous imipenem or gentamicin and vancomycin should be initiated. Obviously, clinical judgment regarding specific patient risk factors and compliance should play a role in decision making, but these data provide an evidence-based rationale for first-line oral antibiotic selection.

Pilot study of breast sensation after breast reconstruction: Evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery

Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P < 0.05). Implants provided better static (P = 0.071) and moving sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps.

Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects

Soft-Tissue Manipulation Contributes to Craniofacial Symmetry as Importantly as Does Implant Reconstruction in Cranioplasty for Skull Defects

Intra-Arch Elastics Technique: A Novel Method for Controlling the Abutment/Soft Tissue Interface During Implant Reconstruction of the Orofacial Region

In the past 30 years, composite microvascular free tissue transfer has become a popular and highly successful option for the reconstruction of defects in the head and neck region. However, inherent shortcomings exist with free tissue transfer in that the imported tissue often fails to adequately replicate the characteristics of the native tissues. This can lead to difficulties when attempting reconstruction from a surgical and prosthetic standpoint. Endosseous implants are often required to adequately retain prostheses, and management of the peri-implant soft tissues represents a critical challenge for the oral and maxillofacial surgeon. This report describes a novel technique for controlling the implant-abutment-soft tissue interface and the advantages of this technique as it pertains to orofacial reconstruction.

Outcomes of Delayed Abdominal-Based Autologous Reconstruction Versus Latissimus Dorsi Flap Plus Implant Reconstruction in Previously Irradiated Patients

Local recurrence after breast conservation therapy is usually managed with salvage mastectomy. Multiple methods of reconstruction are possible, although delayed autologous reconstruction provides the most reliable results. We compared complications in delayed abdominal-based [transverse rectus abdominis muscle (TRAM)/deep inferior epigastric perforator (DIEP)] reconstruction with delayed latissimus dorsi plus implant-based reconstruction in previously irradiated breasts. The authors reviewed 133 consecutive cases of delayed breast reconstructions performed in patients who had postmastectomy radiation therapy and reconstruction with abdominal-based methods (single-pedicle TRAM, supercharged pedicle TRAM, muscle-sparing TRAM free flap, DIEP flap, and superficial inferior epigastric artery flap) or a pedicled latissimus dorsi flap plus implant. Complications for donor and recipient sites were recorded including infection, seroma, hematoma, and partial flap loss. Seventy-five patients were reconstructed with abdominal-based flaps (37 muscle-sparing TRAMs, 19 pedicled TRAMs, 12 DIEPs, 6 supercharged pedicled TRAMs, and 1 superficial inferior epigastric artery). Their median age was 50 years and mean follow-up was 22.7 months. Three (4.0%) patients required reoperation during the same hospital visit for vascular compromise that resulted in 2 (2.7%) flap failures. Three (4.0%) patients had partial flap loss that ultimately required debridement and primary closure. Seventeen (22.7%) patients had minor complications including seroma, small hematoma, cellulitis, and abdominal bulge. Fifty-six patients were reconstructed with latissimus dorsi flaps plus implants. Their median age was 47 years and mean follow-up was 32 months. Three (5.4%) patients developed infections resulting in implant loss. Four (7.1%) patients had partial flap loss that required debridement and primary closure. Thirteen (23.2%) patients had minor complications including seroma (12 patients) and hematoma (1 patient) that required drainage. Fisher exact test was used to determine statistical significance of complication and failure rates between the 2 types of reconstruction. In patients who had postmastectomy radiation therapy, those with abdominal-based reconstructions had fewer complications compared with latissimus dorsi flap plus implant reconstructions (28.0% vs 30.4%, P=0.846). Also, fewer reconstructions failed in patients with abdominal-based reconstruction (2.7% vs 5.4%, P=0.650). Abdominal-based autologous reconstruction had fewer complications and fewer reconstruction failures than latissimus dorsi flap plus implant reconstructions in patients with postmastectomy radiation therapy in our series; however, these rates were not statistically significant.

Skin-reducing Mastectomy with Primary Implant Reconstruction.

Background: We present a series of skin-sparing mastectomies (SSMs) with skin reduction and immediate breast reconstruction to treat large and ptotic breasts. The technique combines oncological mastectomy with immediate subpectoral implant placement as a single-step procedure. Methods: Data was collected from a prospective database from February 2009 to April 2011. A total of 24 patients with macromastia or pronounced ptosis fulfilled the criteria for skin-saving mastectomy. All operations were carried out as a single-step procedure with adaptation of the contralateral breast by reduction mastopexy. Results: A total of 27 SSMs were performed in 24 patients. The mean implant volume was 265 cm3. Immediate reconstruction of the nipple-areola complex was done in 22 patients. The cosmetic and functional results were assessed in all patients 6 months postoperatively; mean follow-up time was 13 months. Mean patient age was 49 years. The cosmetic result was assessed as "very good" or "good" by 22 patients; 2 patients graded the result as "unsatisfactory". There was one local recurrence. Conclusion: Our results support the use of this technique as a safe oncoplastic procedure which is well tolerated by patients.

Esthetic Transformation of a Failed Implant Reconstruction to Fixed-Supported Prosthesis: A Case Report

This article describes a clinical situation where an ill-fitting prosthesis supported by malpositioned dental implants was esthetically transformed to fixed definitive restorations. Provisional restorations were used as a blueprint for fabrication of definitive restorations.

Breast reconstruction in bilateral prophylactic mastectomy patients: Factors that influence decision making

Utilization of bilateral prophylactic mastectomy (BPM) and reconstruction has increased secondary to numerous medical advances. The purpose of this study was to examine decision making in women electing this therapy to further understand what influences and drives this decision. The authors conducted a survey study, enrolling patients who elected BPM and reconstruction. Participants were mailed structured questionnaires utilizing validated and study specific tools addressing: demographics, treatment decisions, autonomy, decision making and information seeking preferences, and breast cancer treatment knowledge. Analysis was performed overall and by reconstruction. 40 patients responded (20 autologous, 19 implant and 1 combination, 66% response rate). The cohort was well educated and wealthy. Reconstructive options played a large role in the consideration of BPM. Patients were influenced by their physicians and less so by non-traditional means (media, internet, etc). Autologous reconstructions had a stronger desire to utilize their own tissue (p < 0.001) and were less concerned with the amount of surgery (0.02) and resulting scars (p = 0.01). Implant reconstructions more often stated that they did not have enough tissue for autologous reconstruction (p < 0.001) and did have a lower BMI, 24.2 vs. 27.5 (p = 0.03). Additionally, they were more influenced by non-traditional means (p < 0.001) and by other patients (p = 0.02). Multiple factors influence decision making in BPM and reconstruction, with the ultimate choice in reconstruction involving tissue availability, appearance of implant reconstructions, total amount of surgery required, and extent of visible scars. Patients were strongly influenced by their physicians, and less so by non-traditional means.

Quantifying the Impact of Immediate Reconstruction in Postmastectomy Radiation: A Large, Dose-Volume Histogram-Based Analysis

To assess the impact of immediate breast reconstruction on postmastectomy radiation (PMRT) using dose-volume histogram (DVH) data. Two hundred forty-seven women underwent PMRT at our center, 196 with implant reconstruction and 51 without reconstruction. Patients with reconstruction were treated with tangential photons, and patients without reconstruction were treated with en-face electron fields and customized bolus. Twenty percent of patients received internal mammary node (IMN) treatment. The DVH data were compared between groups. Ipsilateral lung parameters included V20 (% volume receiving 20 Gy), V40 (% volume receiving 40 Gy), mean dose, and maximum dose. Heart parameters included V25 (% volume receiving 25 Gy), mean dose, and maximum dose. IMN coverage was assessed when applicable. Chest wall coverage was assessed in patients with reconstruction. Propensity-matched analysis adjusted for potential confounders of laterality and IMN treatment. Reconstruction was associated with lower lung V20, mean dose, and maximum dose compared with no reconstruction (all P<.0001). These associations persisted on propensity-matched analysis (all P<.0001). Heart doses were similar between groups (P=NS). Ninety percent of patients with reconstruction had excellent chest wall coverage (D95 >98%). IMN coverage was superior in patients with reconstruction (D95 >92.0 vs 75.7%, P<.001). IMN treatment significantly increased lung and heart parameters in patients with reconstruction (all P<.05) but minimally affected those without reconstruction (all P>.05). Among IMN-treated patients, only lower lung V20 in those without reconstruction persisted (P=.022), and mean and maximum heart doses were higher than in patients without reconstruction (P=.006, P=.015, respectively). Implant reconstruction does not compromise the technical quality of PMRT when the IMNs are untreated. Treatment technique, not reconstruction, is the primary determinant of target coverage and normal tissue doses.