Abstract
Background
Expander-based breast reconstructions in irradiated chest walls have been documented to result in an increased risk of complications including skin necrosis, extrusion, displacement, and capsule contracture. In this article, thoracic cage deformity and rib fractures were investigated following breast reconstruction by tissue expansion.
Methods
A prospective series of 89 immediate postmastectomy tissue expander breast mound reconstructions in 81 patients, the patients were divided into two groups, reconstruction with radiotherapy (n = 37) and without radiotherapy (n = 52). The patients were observed for any sudden severe pain and development of capsule contracture; intraoperative assessment was done first during expander insertion then after exchange of expander with implant to detect any deformity of the chest wall. CT scans were done as an objective way to support the clinical findings in patients who developed flat or concave chest wall deformities.
Results
Patients who had reconstructions with radiotherapy developed severe capsular contractures causing severe pain and limitation in breast expansion in 35 % of reconstructions compared with 5.7 % in the control group. Twenty-six reconstructions (70.2 %) in the study group developed chest wall deformities; in four of them, the deformity was concave, and two patients (5.4 %) developed multiple rib fractures at the expander site. The overall rate of ribcage deformities in the control group was 32.6 %; all of them were simple flattening with no concave deformities. No fractures were noted in the control group.
Conclusions
Expander-based breast reconstruction in combination with radiotherapy and tight unyielding overlying skin and capsule can redirect the expansion force toward the thoracic ribcage rather than the skin causing rib deformities and possible fractures.
Level of Evidence: Level IV, risk/prognostic study
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References
Percec I, Buchy LP (2008) Successful prosthetic breast reconstruction after radiation therapy. Ann Plast Surg 60(5):527–531
Nava MB, Pennati AE, Lozza L, Spano A, Zambetti M, Catanuto G (2011) Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg 128(2):353–359
Hvilsom GB, Holmich LR, Steding-Jessen M et al (2012) Delayed breast implant reconstruction: is radiation therapy associated with capsular contracture or reoperation? Ann Plast Surg 68(3):246–252
Kronowitz SJ, Robb GL (2009) Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 124(2):395–408
Huang X, Qu X, Li Q (2011) Risk factors for complications of tissue expansion: a 20-year systematic review and meta-analysis. Plast Reconstr Surg 128(3):787–797
Slezak S (2011) Discussion: outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg 128(2):360–361
Monticciolo DL, Sincleair ST, Hajdik RL (2010) Rib fracture as a complication of accelerated partial breast irradiation diagnosed on MRI. Breast J 16(4):424–427
Hirbe A, Morgan AE, Uluckan O et al (2006) Skeletal complications of breast cancer therapies. Clin Cancer Res 12(20 supp):6309–6314s
Momoh AO, Colakoglu S, Blacam C, Gautam S, Tobias AM, Lee BT (2012) Delayed autologous breast reconstruction after postmastectomy radiation therapy: is there an optimal time? Ann Plast Surg 69(1):14–18
Zahavi A, Sklair ML, Ad-El DD (2006) Capsular contracture of the breast: working towards a better classification using clinical and radiologic assessment. Ann Plast Surg 57(3):248–251
Liljegren A, Unukovych D, Gagliardi G et al (2014) No difference in dose distribution in organs at risk in postmastectomy radiotherapy with or without breast implant reconstruction. Radiat Oncol 9:14
Ho AY, Patel N, Ohri N et al (2014) Bilateral implant reconstruction does not affect the quality of postmastectomy radiation therapy. Med Dosim 39:18–22
Dickson MG, Sharpe DT (1987) The complications of tissue expansion in breast reconstruction: a review of 75 cases. Br J Plast Surg 40:629–635
Still JM, Law E, Craft-Coffman B (2000) Skeletal deformities due to tissue expanders: report of two patients. Ann Plast Surg 44:211–213
McKinney P, Edelson R, Terrasse A, Zukowski M (1987) Chest wall deformity following soft tissue expansion for breast reconstruction. Plast Reconstr Surg 80:442–444
Sariguney Y, Ayhan S, Eryilamz T (2008) Chest wall deformity after tissue expansion. Scand J Plast Reconstr Surg Hand Surg 42:108–109
de Wildt RP, Tuinder S, Van der Hulst RR (2009) Substantial chest-wall deformity following tissue expansion after radiotherapy. Eur J Plast Surg 32(6):337–340
Moor EV, Wexler MR, Bar-Ziv Y et al (1996) Chest wall deformity following maximal tissue expansion for breast reconstruction. Ann Plast Surg 36(2):129–132
Tseng J, Huang AH, Wong MS, Whetzel TP, Stevenson TR (2010) Rib fractures: a complication of radiation therapy and tissue expansion for breast reconstruction. Plast Reconstr Surg 125(2):65e–66e
Ciccarelli F (2010) Rib fracture as a complication of tissue expansion in breast reconstruction. Plast Reconstr Surg 126(6):2290–2291
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All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments. Informed consents were obtained from all patients prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.
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Alani, H., Shantour, S. Breast reconstruction by tissue expander after radiotherapy: When the skin does not expand, the rib cage is at risk. Eur J Plast Surg 37, 333–338 (2014). https://doi.org/10.1007/s00238-014-0952-6
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DOI: https://doi.org/10.1007/s00238-014-0952-6