Symphony of rebirth: a retrospective comparative cohort study on heterologous breast reconstruction after radiotherapy.

Background: While radiotherapy is a fundamental component of breast-conserving therapy for early breast cancer, it can complicate subsequent reconstructive procedures due to its impact on tissue quality. Despite the growing use of implant-based reconstruction, limited data are available on its safety and aesthetic outcomes in patients previously treated with radiotherapy. This study aims to evaluate the effectiveness and safety of heterologous breast reconstruction using tissue expanders and implants in irradiated patients compared to non-irradiated controls.

Methods: This retrospective comparative cohort study included patients who underwent mastectomy with heterologous reconstruction between January 2020 and December 2023. Patients were divided into two groups: those with prior radiotherapy following breast-conserving surgery for local recurrence (PRS group) and those without prior radiotherapy (NPRS group). All irradiated patients received a standardized regimen of 50 Gy in 25 fractions. Reconstructions were performed using either prepectoral or subpectoral techniques, with Ti-Loop^® mesh used in all prepectoral cases. Only patients who completed the reconstructive process were included. Follow-up focused on early postoperative outcomes within 120 days. Complications and aesthetic results were evaluated, with the latter assessed by an independent plastic surgeon.

Results: A total of 175 patients were included: 15 in the PRS group and 160 in the NPRS group. No statistically significant differences were found in postoperative complication rates, including hematoma (13% PRS vs. 5.6% NPRS, P=0.28), infection (6.6% vs. 5.6%, P>0.99), and wound dehiscence (6.6% vs. 5.6%, P>0.99). Most patients were discharged on the first postoperative day in both groups (80% PRS vs. 81.9% NPRS). Aesthetic scores ≥4 were achieved in 86.7% of PRS and 88% of NPRS patients.

Conclusions: Implant-based breast reconstruction appears to be a viable option for patients with prior radiotherapy when performed with careful planning and standardized protocols. However, due to the small sample size of the irradiated group and limited follow-up duration, larger and longer-term studies are needed to validate these findings and assess long-term complications.