RECONSTRUCTION AND THE RADIATED BREAST - IS THERE A ROLE FOR IMPLANTS

The use of breast implants in irradiated patients is controversial. Re cently, 39 irradiated implants were compared with 338 nonirradiated im plants in 297 patients between January of 1975 and October of 1994 at The University of Texas M. D. Anderson Cancer Center. Tissue expanders and follow-up time of less than 6 months excluded patients from the s tudy. Five groups of patients were identified. Group 1 consisted of 7 patients and 7 implants who received postoperative adjuvant radiothera py after implant placement. Group 2 consisted of 5 patients and 7 impl ants who received preoperative adjuvant radiotherapy prior to implant placement. Groups 3 and 4 consisted of 2 and 12 patients (2 and 19 imp lants) placed beneath latissimus dorsi flaps who had postoperative and preoperative adjuvant radiotherapy, respectively. Group 5 contained 4 patients with 4 implants placed beneath a transverse rectus abdominis myocutaneous (TRAM) flap who had preoperative radiotherapy. All impla nts were placed submuscularly or beneath autogenous flaps. The average irradiated breast received 50 Gy. For statistical purposes, two categ ories were identified. Capsular contracture (Baker III or greater), pa in, exposure, and implant removal in 6 of 14 implants that received ra diotherapy were compared with similar complications in 33 of 266 impla nts without irradiation (p = 0.001). The second category contained 10 complications in 25 implants placed beneath autogenous reconstructions with radiotherapy compared with 6 of 72 similar complications in impl ants placed beneath autogenous reconstructions without radiotherapy (p = 0.000). Results showed that irradiation has significant negative ef fects on the reconstructive outcome with implants. Autogenous reconstr uction did not appear to offer a protective role when placed over impl ants. Because of radiotherapy's negative influence, we would thus advo cate autogenous breast reconstruction alone in patients who have under gone or are about to undergo radiotherapy.