A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy

Abstract

Background

Immediate breast reconstruction may result in superior cosmetic outcomes as a result of the preservation of the skin envelope. The impact of implant use and radiotherapy (RT) on the cosmetic outcome of latissimus dorsi (LD) breast reconstruction, however, has never been prospectively evaluated with adequate long-term follow-up.

Methods

Women undergoing immediate LD breast reconstruction from January 2000 to February 2007 underwent photographic assessment and clinical evaluation for breast retraction analysis (BRA) at 3, 6 and 12 months postoperatively and on the anniversary of their surgery. The resulting photographs were subject to panel cosmetic assessment. A patient-reported cosmetic outcome questionnaire and the body image scale (BIS) were administered to each woman at a single time point to coincide with the anniversary of their surgery. Multilevel linear regression modelling was used to analyse the results.

Results

Seventy-three women underwent 53 implant-assisted LD breast reconstructions and 20 autologous procedures with a mean follow-up of 2.71 years. The incidence of radiotherapy in this cohort was 43%. RT over time adversely influenced overall cosmetic outcome as assessed by the panel (P = 0.0002), and BRA (P = 0.033), both of which were significantly worse in the implant-assisted group (P = 0.020). Patient reporting of overall cosmetic outcome and BIS, however, did not differ significantly between the LD groups or following RT.

Conclusion

Radiotherapy may adversely affect the cosmetic outcome of latissimus dorsi breast reconstruction, particularly if an implant is used, but this is not universal. Patient assessment of their cosmetic outcome may, however, differ significantly from the clinician’s view.

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ACKNOWLEDGEMENT

The authors would like thank the Bristol Breast Unit’s breast care nurses responsible for ZEW’s patients regarding informed consent in breast reconstruction (BR) and their encouragement of patients attending the BR clinic: Ms Miranda Cooper, Ms Angie Nicholson, Ms Naomi Day, Ms Lorna Taylor and Ms Caroline Fuller.

Conflict of interest statements: This study was funded in part by an educational grant to ZEW from Allergan Medical. The funder had no role in study design, analysis of data, reporting of findings or the decision to publish. All authors have no conflicts of interest with the contents of this paper.

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Correspondence to Zoë Ellen Winters PhD.

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Financial support: Allergan Medical UK, United Bristol Healthcare Trust Charitable Trustees

Appendix 1. Study-specific Cosmetic Outcome Questionnaire

Appendix 1. Study-specific Cosmetic Outcome Questionnaire

This questionnaire asks for your opinion of the outcome of your breast reconstruction when undressed, comparing your reconstructed breast to your other breast.

If you have had both breasts reconstructed, please answer the questions for your most recent reconstruction.

For each question, please circle the relevant number.

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Thomson, H.J., Potter, S., Greenwood, R.J. et al. A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy. Ann Surg Oncol 15, 1081–1091 (2008). https://doi.org/10.1245/s10434-007-9772-2

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Keywords

  • Breast reconstruction
  • Cosmetic
  • Latissimus
  • Prospective
  • Radiotherapy