Association of radiation timing with long-term satisfaction and health-related quality of life in prosthetic breast reconstruction Journal Article


Authors: Nelson, J. A.; Cordeiro, P. G.; Polanco, T.; Shamsunder, M. G.; Patel, A.; Allen, R. J. Jr; Matros, E.; Disa, J. J.; Cuaron, J. J.; Morrow, M.; Mehrara, B. J.; Pusic, A. L.; McCarthy, C. M.
Article Title: Association of radiation timing with long-term satisfaction and health-related quality of life in prosthetic breast reconstruction
Abstract: Background: Radiation therapy is increasingly used after breast cancer surgery, which may impact patients' postoperative quality of life. This study assessed differences in long-term patient satisfaction and health-related quality of life after radiation therapy administered at different stages of implant-based breast reconstruction or with no radiation after surgery. Methods: In this observational study, long-term outcomes were evaluated for four cohorts of women who completed breast reconstruction and received (1) no radiation, (2) radiation before tissue expander placement, (3) radiation after tissue expander placement, or (4) radiation after permanent implant between 2010 and 2017 at Memorial Sloan Kettering. Satisfaction and health-related quality of life were assessed using the prospectively collected Satisfaction with Breasts and Physical Well-Being of Chest BREAST-Q subscales. Score distributions were examined by radiation exposure status for 3 years after surgery using nonparametric analyses and regression models. Results: Of 2932 patients who met the inclusion criteria, 25.8 percent received radiation during breast cancer treatment, including before tissue expander placement (n = 239; 8.2 percent), after tissue expander placement (n = 290; 9.9 percent), and after implant placement (n = 228; 7.8 percent). Radiotherapy patients had average scores 7 to 9 points lower at all postoperative time points for Satisfaction with Breasts and Physical Well-Being of Chest subscales (p < 0.001). Although patient-reported outcomes did not differ by radiation timing, there were higher rates of severe capsular contracture with postimplant radiotherapy (p < 0.001). Conclusions: Radiation therapy significantly affected patient satisfaction and health-related quality of life following implant breast reconstruction through 3 years postoperatively. Patient perception of outcome was unaffected by radiotherapy timing; however, capsular contracture was higher after postimplant radiotherapy, suggesting there may be an advantage to performing radiotherapy before placement of the final reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. © 2022 Lippincott Williams and Wilkins. All rights reserved.
Keywords: treatment outcome; retrospective studies; quality of life; breast neoplasms; breast reconstruction; mammaplasty; retrospective study; tissue expansion devices; breast tumor; satisfaction; breast endoprosthesis; breast implants; breast augmentation; personal satisfaction; tissue expander; breast implantation; adverse event; contracture; humans; human; female
Journal Title: Plastic and Reconstructive Surgery
Volume: 150
Issue: 1
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2022-07-01
Start Page: 32e
End Page: 41e
Language: English
DOI: 10.1097/prs.0000000000009180
PUBMED: 35499580
PROVIDER: scopus
PMCID: PMC9453854
DOI/URL:
Notes: Article -- Export Date: 1 August 2022 -- Source: Scopus
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MSK Authors
  1. Monica Morrow
    777 Morrow
  2. Joseph Disa
    266 Disa
  3. Andrea Pusic
    300 Pusic
  4. Babak Mehrara
    462 Mehrara
  5. Peter G Cordeiro
    288 Cordeiro
  6. Evan Matros
    210 Matros
  7. Colleen Marie McCarthy
    144 McCarthy
  8. John Jacob Cuaron
    144 Cuaron
  9. Robert J Allen Jr
    102 Allen Jr
  10. Jonas Allan Nelson
    226 Nelson
  11. Thais O Polanco
    24 Polanco
  12. Aadit R Patel
    7 Patel
  13. Assem Manoj Patel
    2 Patel