Prosthetic breast reconstruction outcomes “do not deteriorate over time”, according to a major study of more than 2,200 US patients treated over two decades.

Breast reconstruction has become an essential part of breast cancer care, with an increasing number of patients seeking reconstruction after mastectomy. Among currently available techniques, two-stage, prostheticbased reconstruction with immediate tissue expander placement, followed by exchange for permanent implant, remains the most common form of breast reconstruction performed.

While numerous studies have examined outcomes following implant reconstruction (including rates of acute complications and associated preoperative and operative risk factors) the majority of these studies have been limited by short-term follow-up and/or lack of evaluation of aesthetic outcomes. In addition, only more recently have data become available examining patient-reported outcomes, which provide a measurement of patient satisfaction following implantbased reconstruction.

Due to the lack of available data, several concepts related to longterm outcomes following prosthetic breast reconstruction “have formed from surgical dogma rather than objective data” explained Dr Akhil Seth at NorthShore University in Illinois and Dr Peter Cordeiro at Memorial Sloan Kettering Cancer Center in New York, who examined long-term surgeon-reported and patient-reported outcomes following two-stage prosthetic breast reconstruction among 2,284 patients (3,489 breasts) treated from 1994 to 2016.

Their study, published in the journal Plastic and Reconstructive Surgery, found “aesthetic scores and capsular contracture rates remained stable during the entire follow-up period”.

Among specific procedures, bilateral and nonirradiated reconstructions “consistently had the highest aesthetic scores, while unilateral irradiated breasts had the lowest”. High rates of capsular contracture “were seen consistently with irradiated breasts, although the extent of contracture improved over time in all patients”.

Over time, there was “stability or improvement in patient-reported BREAST-Q scores in all patients. There was comparable long-term satisfaction with outcomes between irradiated and non-irradiated patients, despite significant differences in satisfaction with their breasts.”

The authors noted: “These results contradict the surgical dogma surrounding prosthetic breast reconstruction and therefore should be given significant consideration when counselling patients.”

Sources: Plastic and Reconstructive Surgery and