Prosthetic breast reconstruction

Indications and update

Tam T. Quinn, George S. Miller, Marie Rostek, Miguel S. Cabalag, Warren M. Rozen, David J. Hunter-Smith

Research output: Contribution to journalReview ArticleResearchpeer-review

19 Citations (Scopus)

Abstract

Background: Despite 82% of patients reporting psychosocial improvement following breast reconstruction, only 33% patients choose to undergo surgery. Implant reconstruction outnumbers autologous reconstruction in many centres. Methods: A systematic review of the literature was undertaken. Inclusion required: (I) Meta-analyses or review articles; (II) adult patients aged 18 years or over undergoing alloplastic breast reconstruction; (III) studies including outcome measures; (IV) case series with more than 10 patients; (V) English language; and (VI) publication after 1st January, 2000. Results: After full text review, analysis and data extraction was conducted for a total of 63 articles. Definitive reconstruction with an implant can be immediate or delayed. Older patients have similar or even lower complication rates to younger patients. Complications include capsular contracture, hematoma and infection. Obesity, smoking, large breasts, diabetes and higher grade tumors are associated with increased risk of wound problems and reconstructive failure. Silicone implant patients have higher capsular contracture rates but have higher physical and psychosocial function. There were no associations made between silicone implants and cancer or systemic disease. There were no differences in outcomes or complications between round and shaped implants. Textured implants have a lower risk of capsular contracture than smooth implants. Smooth implants are more likely to be displaced as well as having higher rates of infection. Immediate breast reconstruction (IBR) gives the best aesthetic outcome if radiotherapy is not required but has a higher rate of capsular contracture and implant failure. Delayed-immediate reconstruction patients can achieve similar aesthetic results to IBR whilst preserving the breast skin if radiotherapy is required. Delayed breast reconstruction (DBR) patients have fewer complications than IBR patients. Conclusions: Implant reconstruction is a safe and popular mode of post-mastectomy reconstruction. Evidence exists for the settings in which complications are more likely, and we can now more reliably predict outcomes of reconstruction on an individual basis and assess patient suitability.

Original languageEnglish
Pages (from-to)174-186
Number of pages13
JournalGland Surgery
Volume5
Issue number2
DOIs
Publication statusPublished - 1 Apr 2016

Keywords

  • Alloplastic
  • Breast cancer
  • Breast implant
  • Prosthesis
  • Reconstruction
  • Tissue expander

Cite this

Quinn, Tam T. ; Miller, George S. ; Rostek, Marie ; Cabalag, Miguel S. ; Rozen, Warren M. ; Hunter-Smith, David J. / Prosthetic breast reconstruction : Indications and update. In: Gland Surgery. 2016 ; Vol. 5, No. 2. pp. 174-186.
@article{96bba530aa8a408f8007c825b9304a4b,
title = "Prosthetic breast reconstruction: Indications and update",
abstract = "Background: Despite 82{\%} of patients reporting psychosocial improvement following breast reconstruction, only 33{\%} patients choose to undergo surgery. Implant reconstruction outnumbers autologous reconstruction in many centres. Methods: A systematic review of the literature was undertaken. Inclusion required: (I) Meta-analyses or review articles; (II) adult patients aged 18 years or over undergoing alloplastic breast reconstruction; (III) studies including outcome measures; (IV) case series with more than 10 patients; (V) English language; and (VI) publication after 1st January, 2000. Results: After full text review, analysis and data extraction was conducted for a total of 63 articles. Definitive reconstruction with an implant can be immediate or delayed. Older patients have similar or even lower complication rates to younger patients. Complications include capsular contracture, hematoma and infection. Obesity, smoking, large breasts, diabetes and higher grade tumors are associated with increased risk of wound problems and reconstructive failure. Silicone implant patients have higher capsular contracture rates but have higher physical and psychosocial function. There were no associations made between silicone implants and cancer or systemic disease. There were no differences in outcomes or complications between round and shaped implants. Textured implants have a lower risk of capsular contracture than smooth implants. Smooth implants are more likely to be displaced as well as having higher rates of infection. Immediate breast reconstruction (IBR) gives the best aesthetic outcome if radiotherapy is not required but has a higher rate of capsular contracture and implant failure. Delayed-immediate reconstruction patients can achieve similar aesthetic results to IBR whilst preserving the breast skin if radiotherapy is required. Delayed breast reconstruction (DBR) patients have fewer complications than IBR patients. Conclusions: Implant reconstruction is a safe and popular mode of post-mastectomy reconstruction. Evidence exists for the settings in which complications are more likely, and we can now more reliably predict outcomes of reconstruction on an individual basis and assess patient suitability.",
keywords = "Alloplastic, Breast cancer, Breast implant, Prosthesis, Reconstruction, Tissue expander",
author = "Quinn, {Tam T.} and Miller, {George S.} and Marie Rostek and Cabalag, {Miguel S.} and Rozen, {Warren M.} and Hunter-Smith, {David J.}",
year = "2016",
month = "4",
day = "1",
doi = "10.3978/j.issn.2227-684X.2015.07.01",
language = "English",
volume = "5",
pages = "174--186",
journal = "Gland Surgery",
issn = "2227-684X",
number = "2",

}

Prosthetic breast reconstruction : Indications and update. / Quinn, Tam T.; Miller, George S.; Rostek, Marie; Cabalag, Miguel S.; Rozen, Warren M.; Hunter-Smith, David J.

In: Gland Surgery, Vol. 5, No. 2, 01.04.2016, p. 174-186.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Prosthetic breast reconstruction

T2 - Indications and update

AU - Quinn, Tam T.

AU - Miller, George S.

AU - Rostek, Marie

AU - Cabalag, Miguel S.

AU - Rozen, Warren M.

AU - Hunter-Smith, David J.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background: Despite 82% of patients reporting psychosocial improvement following breast reconstruction, only 33% patients choose to undergo surgery. Implant reconstruction outnumbers autologous reconstruction in many centres. Methods: A systematic review of the literature was undertaken. Inclusion required: (I) Meta-analyses or review articles; (II) adult patients aged 18 years or over undergoing alloplastic breast reconstruction; (III) studies including outcome measures; (IV) case series with more than 10 patients; (V) English language; and (VI) publication after 1st January, 2000. Results: After full text review, analysis and data extraction was conducted for a total of 63 articles. Definitive reconstruction with an implant can be immediate or delayed. Older patients have similar or even lower complication rates to younger patients. Complications include capsular contracture, hematoma and infection. Obesity, smoking, large breasts, diabetes and higher grade tumors are associated with increased risk of wound problems and reconstructive failure. Silicone implant patients have higher capsular contracture rates but have higher physical and psychosocial function. There were no associations made between silicone implants and cancer or systemic disease. There were no differences in outcomes or complications between round and shaped implants. Textured implants have a lower risk of capsular contracture than smooth implants. Smooth implants are more likely to be displaced as well as having higher rates of infection. Immediate breast reconstruction (IBR) gives the best aesthetic outcome if radiotherapy is not required but has a higher rate of capsular contracture and implant failure. Delayed-immediate reconstruction patients can achieve similar aesthetic results to IBR whilst preserving the breast skin if radiotherapy is required. Delayed breast reconstruction (DBR) patients have fewer complications than IBR patients. Conclusions: Implant reconstruction is a safe and popular mode of post-mastectomy reconstruction. Evidence exists for the settings in which complications are more likely, and we can now more reliably predict outcomes of reconstruction on an individual basis and assess patient suitability.

AB - Background: Despite 82% of patients reporting psychosocial improvement following breast reconstruction, only 33% patients choose to undergo surgery. Implant reconstruction outnumbers autologous reconstruction in many centres. Methods: A systematic review of the literature was undertaken. Inclusion required: (I) Meta-analyses or review articles; (II) adult patients aged 18 years or over undergoing alloplastic breast reconstruction; (III) studies including outcome measures; (IV) case series with more than 10 patients; (V) English language; and (VI) publication after 1st January, 2000. Results: After full text review, analysis and data extraction was conducted for a total of 63 articles. Definitive reconstruction with an implant can be immediate or delayed. Older patients have similar or even lower complication rates to younger patients. Complications include capsular contracture, hematoma and infection. Obesity, smoking, large breasts, diabetes and higher grade tumors are associated with increased risk of wound problems and reconstructive failure. Silicone implant patients have higher capsular contracture rates but have higher physical and psychosocial function. There were no associations made between silicone implants and cancer or systemic disease. There were no differences in outcomes or complications between round and shaped implants. Textured implants have a lower risk of capsular contracture than smooth implants. Smooth implants are more likely to be displaced as well as having higher rates of infection. Immediate breast reconstruction (IBR) gives the best aesthetic outcome if radiotherapy is not required but has a higher rate of capsular contracture and implant failure. Delayed-immediate reconstruction patients can achieve similar aesthetic results to IBR whilst preserving the breast skin if radiotherapy is required. Delayed breast reconstruction (DBR) patients have fewer complications than IBR patients. Conclusions: Implant reconstruction is a safe and popular mode of post-mastectomy reconstruction. Evidence exists for the settings in which complications are more likely, and we can now more reliably predict outcomes of reconstruction on an individual basis and assess patient suitability.

KW - Alloplastic

KW - Breast cancer

KW - Breast implant

KW - Prosthesis

KW - Reconstruction

KW - Tissue expander

UR - http://www.scopus.com/inward/record.url?scp=84999751275&partnerID=8YFLogxK

U2 - 10.3978/j.issn.2227-684X.2015.07.01

DO - 10.3978/j.issn.2227-684X.2015.07.01

M3 - Review Article

VL - 5

SP - 174

EP - 186

JO - Gland Surgery

JF - Gland Surgery

SN - 2227-684X

IS - 2

ER -