Silicone Shell Breast Implants in Patients Undergoing Risk-Reducing Mastectomy With a History of Breast-Conserving Surgery and Adjuvant Radiotherapy. A Long-Term Study.

BACKGROUND: Indications for breast-conserving surgery and adjuvant radiotherapy (BCSAR) in patients with breast carcinoma are increasing, as are indications for risk-reducing mastectomy (RRM) in healthy subjects. Most of these cases are reconstructed with silicone shell breast implants (SSBI).

OBJECTIVES: To study complications of silicone shell breast implants (SSBI) in breast reconstruction in patients undergoing RRM with previous BCSAR.

METHODS: A prospective-cohort study was designed. The study group includes cases of RRM reconstructed with SSBI in patients who had previously undergone BCSAR in the same breast. The control group consists of patients with high-risk breast cancer who have undergone RRM and immediate SSBI reconstruction without previous BCSAR.

RESULTS: There was a history of BCSAR in 15.8% of cases. The first SSBI used in immediate reconstruction after RRM was replaced in 51.5% of cases with a mean survival of 24.04 ± 28.48 months. BCSAR was significantly associated to pathological capsular contracture (P=0.00) in this first SSBI (37.5% vs 5.9%). Of the cases requiring the replacement of the first SSBI, 44.23% suffered failure of the second SSBI, with a mean survival of 27.95 ± 26.53 months. No significant association was found between the consecutive development of capsular contracture in the second SSBI and previous history of BCSAR (P=0.10).

CONCLUSIONS: BCSAR prior to RRM reconstructed using SSBI is associated with a significant increase in pathological capsular contracture. Patients should be warned of the high rate of SSBI complications and reconstruction failure. Polyurethane-coated implants may provide an alternative in cases in which alloplastic reconstruction is considered in patients with previous BCSAR.