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The Other Side: Investigating Revisions and Reconstructions of the Non-Radiated Breast
Malia Voytik
*, Salman Khan, Margaret M. Hornick, Ayaka N. Deguchi, Robyn B. Broach, Said Azoury
Plastic Surgery, University of Pennsylvania, Philadelphia, PA
Background: Radiation following implant-based reconstruction (IBR) is associated with a greater complication profile as well as breast asymmetry, which affects aesthetic outcomes and can require revision procedures. This study aims to quantify the impact of unilateral post-mastectomy radiation therapy (PMRT) on outcomes following bilateral IBR.
Methods: A single-center retrospective review was performed on patients who underwent bilateral IBR followed by unilateral PMRT from 2017-2022. Outcomes between radiated and non-radiated breasts were compared.
Results: The cohort included 167 patients with median age of 46 years (IQR 40-53) and BMI 23.9 kg/m2 (21.2-27.9). The median follow-up was 23.9 months (11.0-39.7). Most (86%) patients had two-stage reconstruction, and 68.9% underwent a revision procedure. Capsular contracture was reported in 10.8% of patients, more frequently on the radiated side (9.0% vs 1.8%, p=0.006). Wound healing complications, including seroma (p=0.7), hematoma (p=0.8), skin necrosis (p=0.8), delayed wound healing (p=0.11), and surgical site infection (p=0.8), were comparable bilaterally. Overall, 70 radiated and 58 non-radiated breasts required revision procedures. Skin-reducing breast lift on the non-radiated side was performed to improve symmetry in 11% of patients (p<0.001). Other procedures, including fat grafting (17% vs 18%, p>0.9), capsulectomy (7.2% vs 3.6%, p=0.2), capsulotomy (13% vs 8.4%, p=0.3), and latissimus dorsi flap (1.2% vs 0%, p=0.5), were not significantly different between radiated and non-radiated breasts.
Conclusion: Most patients undergoing unilateral PMRT following bilateral IBR require revision, more commonly to the radiated breast. Patients should be counseled during preoperative planning on the high likelihood of needing revision procedures.
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