Implant-Based Breast Reconstruction with Autologous Lower Dermal Sling and Radiation Therapy Outcomes

Abstract

Immediate breast reconstruction surgery (IBRS) with a sub-pectoral placement of implant improves quality of life of patients undergoing a mastectomy. Implant-based IBRS with autologous lower dermal sling (ALDS) procedure provides an effective surgical alternative to acellular dermal matrices. However, the influence of this procedure on radiation therapy (RT) outcomes remains unclear. This study aims at investigating post-surgery complications after 1 year in patients who have undergone IBRS-ALDS and RT. In this single-institution retrospective study, 78 implant-based IBRS patients with data available for a minimum of 1-year follow-up were stratified into group A (n = 40; IBRS) and group B (n = 38; IBRS + RT). Based on the use of ALDS procedure, group A patients were further stratified into sub-groups A1 (conventional IBRS; n = 21) and A2 (ALDS-IBRS; n = 19). Similarly, group B patients were sub-stratified into sub-groups B1 (conventional IBRS + RT; n = 18) and B2 (ALDS-IBRS + RT; n = 20). Clinical assessment and patient-reported outcome measures (PROMs) after 1-year post-surgery were conducted using Baker classification and BREAST-Q questionnaire, respectively. Patients in sub-group B1 exhibited higher percentages of overall major complications (41.6%) when compared to sub-group B2 (8.2%). Capsular contracture (12.5%) and reconstruction failure (20.8%) rates were higher for sub-group B1 vis-a-vis sub-group B2. Superior breast reconstruction outcomes with psycho-social well-being were observed in group B patients in comparison to group A (p < 0.05). Preliminary outcomes after a 1-year follow-up indicate that patients undergoing ALDS-IBRS exhibit reduced rate of RT-associated complications. IBRS-ALDS may obviate the need of ADMs in low-resource settings.

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Abbreviations

BC:

Breast cancer

IBRS:

Immediate breast reconstruction surgery

ADMs:

Acellular dermal matrices

ALDS:

Autologous lower dermal sling

RT:

Radiation therapy

OBHC:

Orchids Breast Health Clinic

3D-CRT:

Three-dimensional conformal radiotherapy

PROMs:

Patient-reported outcome measures

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Acknowledgments

The study authors would like to thank all participants who willingly participated in this study. We also acknowledge the unstinting support of the Bajaj Auto Ltd. for providing support to research activities at OBHC, Pune. The contribution of Laxmi Shekhawat in BREAST-Q analysis is acknowledged. We are grateful to the MAPI Research Trust for the permission to use BREAST-Q (http://www.mapitrust.org). We also thank Prof. L.S. Shashidhara (Indian Institute of Science Education and Research, Pune) for the suggestions and advice throughout the work. We would also like to thank the management and staff of Ruby Hall Clinic, Pune, where all surgeries were performed.

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C.B.K., A.U.N., S.D., and G.S. contributed to the study concept, design, and manuscript preparation. C.B.K., A.U.N., S.D., R.M., and U.D. analyzed and interpreted the data. L.B. co-ordinated the project and provided administrative support. All authors contributed to the data acquisition, critical article revision, and final approval of the article.

Corresponding author

Correspondence to Chaitanyanand B. Koppiker.

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Koppiker, C.B., Noor, A.U., Dixit, S. et al. Implant-Based Breast Reconstruction with Autologous Lower Dermal Sling and Radiation Therapy Outcomes. Indian J Surg 81, 543–551 (2019). https://doi.org/10.1007/s12262-018-1856-7

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Keywords

  • Immediate breast reconstruction surgery
  • Autologous lower dermal sling
  • Radiation therapy
  • Patient-reported outcome measures
  • Breast cancer