Implant-based, two-stage breast reconstruction in the setting of radiation injury: an outcome study

Plast Reconstr Surg. 2012 Apr;129(4):817-823. doi: 10.1097/PRS.0b013e31824421d0.


Background: More women with breast cancer who either have already had radiation therapy or will be getting radiation therapy as part of their treatment protocol are now seeking implant-based breast reconstruction. The literature on the success of this type of reconstruction in the setting of radiation injury is mixed.

Methods: A single reconstructive surgeon's experience over a 10-year period with implant-based, two-stage breast reconstruction was retrospectively examined. A total of 267 breasts in 194 patients were included in the study and divided into three groups. Reconstruction was performed for breasts that had no radiation exposure (n = 218), radiation exposure before mastectomy/reconstruction (n = 32), or radiation exposure after mastectomy and first-stage reconstruction but before completion of the second stage of reconstruction (n = 17). Age, follow-up time, history (of diabetes, smoking, and chemotherapy), body mass index, and expander volume were recorded. Logistical regression analysis was performed for major reoperative complications following the reconstruction.

Results: Radiation exposure before reconstruction resulted in a 43.8 percent complication rate, during reconstruction had a 41.2 percent complication rate, and no radiation exposure had a 13.8 percent complication rate. The most common complication in both radiation groups was wound dehiscence, but there were also a significant number of patients who had failure of expansion. In addition, smoking significantly influenced the occurrence of complications.

Conclusions: Radiation therapy for the treatment of breast cancer significantly increased the incidence of major, reoperative complications in implant-based, two-stage breast reconstruction. Despite this high rate, however, in the present study, 80 percent of patients with major complications went on to complete their breast reconstructions with either implants or autogenous tissue.

Clinical question/level of evidence: Risk, II.

MeSH terms

  • Adult
  • Breast / radiation effects*
  • Breast Implants*
  • Breast Neoplasms / radiotherapy*
  • Female
  • Humans
  • Mammaplasty / methods*
  • Mastectomy
  • Middle Aged
  • Radiation Injuries / surgery*
  • Surgical Wound Dehiscence
  • Tissue Expansion*