2023•The Breast JournalOpen access
The Effect of Adjuvant Radiotherapy on One- and Two-Stage Prosthetic Breast Reconstruction and on Autologous Reconstruction: A Multicenter Italian Study among 18 Senonetwork Breast Centres
Andrea Vittorio Emanuele Lisa, Marzia Salgarello, Alessandra Huscher, Fabio Corsi, Daniele Piovani, Federica Rubbino, Stefania Andreoletti, Giovanni Papa, Francesco Maria Klinger, Corrado Tinterri, Alberto Testori, Marta Scorsetti, Paolo Veronesi, Maria Cristina Leonardi, Mario Rietjens, Umberto Cortinovis, Valeria Summo, Emanuele Rampino Cordaro, Pier Camillo Parodi, Paolo Persichetti, Mauro Barone, Giorgio De Santis, Matteo Murolo, Michele Riccio, Angelica Aquinati, Francesco Cavaliere, Nicola Vaia, Giulia Pagura, Erica Dalla Venezia, Franco Bassetto, Vincenzo Vindigni, Luigi Ciuffreda, Maria Alessandra Bocchiotti, Alberto Sciarillo, Nadia Renzi, Graziano Meneghini, Tajna Kraljic, Andrea Loreti, Lucio Fortunato, Valentina Pino, Valeriano Vinci, Marco Ettore Attilio Klinger
Abstract
Purpose. In modern breast cancer treatment, a growing role has been observed for breast reconstruction together with an increase in clinical indications for postmastectomy radiotherapy (PMRT). Choosing the optimum type of reconstructive technique is a clinical challenge. We therefore conducted a national multicenter study to analyze the impact of PMRT on breast reconstruction. Methods. We conducted a retrospective case-control multicenter study on women undergoing breast reconstruction. Data were collected from 18 Italian Breast Centres and stored in a cumulative database which included the following: autologous reconstruction, direct-to-implant (DTI), and tissue expander/immediate (TE/I). For all patients, we described complications and surgical endpoints to complications such as reconstruction failure, explant, change in type of reconstruction, and reintervention. Results. From 2001 to April 2020, 3116 patients were evaluated. The risk for any complication was significantly increased in patients receiving PMRT (aOR, 1.73; 95% CI, 1.33–2.24; p < 0.001 ). PMRT was associated with a significant increase in the risk of capsular contracture in the DTI and TE/I groups (aOR, 2.24; 95% CI, 1.57–3.20; p < 0.001 ). Comparing type of procedures, the risk of failure (aOR, 1.82; 95% CI, 1.06–3.12, p = 0.030 ), explant (aOR, 3.34; 95% CI, 3.85–7.83, p < 0.001 ), and severe complications (aOR, 2.54; 95% CI, 1.88–3.43, p < 0.001 ) were significantly higher in the group undergoing DTI reconstruction as compared to TE/I reconstruction. Conclusion. Our study confirms that autologous reconstruction is the procedure least impacted by PMRT, while DTI appears to be the most impacted by PMRT, when compared with TE/I which shows a lower rate of explant and reconstruction failure. The trial is registered with NCT04783818, and the date of registration is 1 March, 2021, retrospectively registered.