Strahlentherapie und Onkologie

, Volume 188, Issue 12, pp 1074–1079

Expander/implant breast reconstruction before radiotherapy

Outcomes in a single-institute cohort
  • C. Aristei
  • L. Falcinelli
  • V. Bini
  • I. Palumbo
  • A. Farneti
  • R.P. Petitto
  • S. Gori
  • E. Perrucci
Original article


Background and purpose

Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes.

Patients and methods

From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy.


At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good (κ-value 0.64; 95% CI: 0.48–0.79).


RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent.


Mastectomy Immediate expander/implant reconstruction Radiotherapy Relapse Prosthesis removal 

Expander-/Implantatrekonstruktion vor Radiotherapie

Ergebnisse einer Einzelzenterkohorte


Hintergründe und Ziel

Radiotherapie (RT) rekonstruierter Brüste hatte oft hohe Komplikationsraten und schlechte kosmetische Ergebnisse.

Diese Studie untersuchte Komplikationsraten, Zusammenhänge zwischen Risikofaktoren und Prothesenentfernung sowie kosmetische Ergebnisse.

Patienten und Methoden

Von 1997 bis 2009 erhielten 101 konsekutive Patientinnen eine RT nach Brustrekonstruktion wegen des Vorliegens von Risikofaktoren für ein Rezidiv (92), oder weil es zu einem Rezidiv gekommen war (9).

Zum Zeitpunkt der RT hatten 90 Patienten vorläufige Gewebeexpander und elf dauerhafte Implantate. Zwölf Patienten erhielten eine neo-adjuvante Chemotherapie; alle Patienten erhielten adjuvante Chemo- und/oder Hormon – Therapie.


Bei einer mittleren Nachbeobachtungszeit von 50 Monaten kam eine späte Toxizität bei 28 Patientinnen vor: Schmerzen in sieben, Lymphödem in sechs, G1 Hauttoxizität in fünf, subkutane Toxizität in 19 (2G1, 9G2, 7G3, 1G4). Mehr als eine Nebenwirkung hatten zwölf Patientinnen. In acht Patienten rupturierte die Prothese (3), dislozierte (3), dislozierte und rupturierte (1) oder verlor ihre Form (1). Kapselzusammenziehung wurde bei 89 Patientinnen als IA in 14, IB in 47, II in 10, III in 11 und IV in 7 Fällen klassifiziert. Zwölf Prothesen (11,9%) wurden entfernt. Der einzige bedeutende Faktor für die Protheseentfernung war das Alter (p = 0,007). Urteile zu kosmetischen Ergebnissen waren von 81 Ärzten und 84 Patienten verfügbar. Das Ergebnis war auch bei 58/81 der Arzturteile und 57/84 der Patientinneneinschätzungen ausgezeichnet bis gut. Die Inter-Rater-Übereinstimmung über das Ergebnis war insgesamt gut (κ-Wert 0,64; 95-%-CI: 0,48–0,79).


RT bei rekonstruierten Brüsten hatte niedrige Komplikationsraten in Bezug auf spätere Nebenwirkungen und Prothesenentfernung. Kosmetische Ergebnisse waren überwiegend ausgezeichnet bis gut.


Brustamputation Unmittelbare Expander/Implant Rekonstruktion Strahlentherapie Rezidiv Prothesenentfernung 


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Copyright information

© Urban & Vogel 2012

Authors and Affiliations

  • C. Aristei
    • 1
  • L. Falcinelli
    • 2
  • V. Bini
    • 3
  • I. Palumbo
    • 1
  • A. Farneti
    • 4
  • R.P. Petitto
    • 2
  • S. Gori
    • 5
  • E. Perrucci
    • 2
  1. 1.Radiation Oncology Section, Department of Surgery, Radiology and DentistryUniversity of Perugia and Santa Maria della Misericordia HospitalPerugiaItaly
  2. 2.Radiation Oncology DivisionSanta Maria della Misericordia HospitalPerugiaItaly
  3. 3.Department of Internal MedicineUniversity of PerugiaPerugiaItaly
  4. 4.Radiation Oncology SectionUniversity of PerugiaPerugiaItaly
  5. 5.Medical Oncology DivisionSanta Maria della Misericordia HospitalPerugiaItaly

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