Outcome of breast implant replacement after radiation therapy: A single-centre retrospective comparative study.

[BACKGROUND] Implant-based breast reconstruction is a common procedure after mastectomy; however, postoperative radiotherapy (RT) increases the risk of developing complications such as capsular contracture, infection and implant failure. We aimed to compare the outcomes of implant replacement in irradiated versus non-irradiated patients and identify risk factors associated with complications in the RT group.

[METHODS] This retrospective study included 83 women who underwent implant replacement after two-stage implant-based reconstruction between 2009 and 2021. Patients were stratified into RT (n=23) and No-RT (n=60) groups. Outcomes assessed included timing of implant replacement, surgical complications, implant failure and need for secondary autologous reconstruction. BREAST-Q patient-reported outcomes were collected at the follow-up. Logistic regression analyses were conducted to identify independent risk factors for complications in RT patients.

[RESULTS] Implant replacement occurred most frequently within 10 years of the initial reconstruction in the RT group compared to the No-RT group (6.1±5.7 years vs 10.5±5.5 years, P=0.001). Capsular contracture was the most frequent indication for implant replacement and was significantly higher in the RT group (P=0.002). RT patients received smaller implants (P=0.001) and underwent adjunctive lipofilling more frequently (P=0.018). Overall postoperative complication rates were significantly higher among the irradiated patients (47.8% vs 18.3, P=0.010). Multivariate logistic regression confirmed BMI [OR:1.51 (95% CI:1.03-2.215, P=0.034) and adjuvant chemotherapy [OR:13.611 (95% CI: 1.127-164.33, P=0.04) as independent predictors of postoperative complications. The BREAST-Q scores were significantly lower in irradiated patients across multiple domains (P<0.05).

[CONCLUSIONS] Implant replacement after RT is associated with increased complications, reconstructive failure and reduced patient satisfaction. Careful patient selection is essential, and autologous reconstruction should be considered when feasible.