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

Emanuele Lisa, Andrea Vittorio; Salgarello, Marzia; Huscher, Alessandra; Corsi, Fabio; Piovani, Daniele; Rubbino, Federica; Andreoletti, Stefania; Papa, Giovanni; Klinger, Francesco; Tinterri, Corrado; Testori, Alberto; Scorsetti, Marta; Veronesi, Paolo; Leonardi, Maria Cristina; Rietjens, Mario; Cortinovis, Umberto; Summo, Valeria; Rampino Cordaro, Emanuele; Parodi, Pier Camillo; Persichetti, Paolo; Barone, Mauro; De Santis, Giorgio; Murolo, Matteo; Riccio, Michele; Aquinati, Angelica; Cavaliere, Francesco; Vaia, Nicola; Pagura, Giulia; Dalla Venezia, Erica; Bassetto, Franco; Vindigni, Vincenzo; Ciuffreda, Luigi; Bocchiotti, Maria Alessandra; Sciarillo, Alberto; Renzi, Nadia; Meneghini, Graziano; Kraljic, Tajna; Loreti, Andrea; Fortunato, Lucio; Pino, Valentina; Vinci, Valeriano; Klinger, Marco

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

Emanuele Lisa, Andrea Vittorio

•

Salgarello, Marzia

•

Huscher, Alessandra

altro

Klinger, Marco

2023

journal article

Periodico

THE BREAST JOURNAL

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.