Post-mastectomy adjuvant radiotherapy for direct-to-implant and two-stage implant-based breast reconstruction: A meta-analysis

Abstract

Background: In recent years, immediate replacement with a prosthesis (direct-to-implant, DTI) is gaining more popularity than two-staged methods (tissue expander followed by an implant, TEI). The safety of immediate implant-based breast reconstruction (IBR) is debatable when postmastectomy radiotherapy (PMRT) is indicated. This meta-analysis aims to evaluate the outcomes of DTI and TEI procedures followed by PMRT.

Methods: Studies searched in the PubMed/Embase/The Cochrane Library databases (1995-2021) were filtered by exclusion criteria. Cases were divided into PMRT and non-irradiated groups, PMRT with a permanent implant or tissue expander. The outcomes were capsular contracture and other complications.

Results: A total of 22 studies with 6964 patients were included. PMRT increased the risk of capsular contracture in DTI patients and caused other complications in TEI patients. In PMRT and non-irradiated groups, the mean rates of capsular contracture were 17.01% versus 3.30% (p < 0.01) in IBR and 15.49% versus 5.70% (p < 0.01) in DTI. The mean rates of other complications were 22.59% versus 11.29% (p < 0.01) in IBR, 31.88% versus 27.87% (p = 0.35) in DTI, and 22.11% versus 9.90% (p < 0.01) in TEI. Implants and tissue expanders caused a similar rate of capsular contracture and other complications.

Conclusion: PMRT is related to a higher risk of complication and capsular contracture in IBR, including DTI procedure. This negative effect may not be related to the type of breast contents during radiotherapy.

Keywords: Capsular contracture; Complications; Immediate breast reconstruction; Implant; Postmastectomy radiotherapy (PMRT).