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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2008

01-04-2008 | Breast Oncology

A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy

Authors: Helen Jane Thomson, MBChB, Shelley Potter, MBChB (Hons), Rosemary Jane Greenwood, MSc., Amit Bahl, MD, Jane Barker, RGN, Simon John Cawthorn, MS, Zoë Ellen Winters, PhD

Published in: Annals of Surgical Oncology | Issue 4/2008

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Abstract

Background

Immediate breast reconstruction may result in superior cosmetic outcomes as a result of the preservation of the skin envelope. The impact of implant use and radiotherapy (RT) on the cosmetic outcome of latissimus dorsi (LD) breast reconstruction, however, has never been prospectively evaluated with adequate long-term follow-up.

Methods

Women undergoing immediate LD breast reconstruction from January 2000 to February 2007 underwent photographic assessment and clinical evaluation for breast retraction analysis (BRA) at 3, 6 and 12 months postoperatively and on the anniversary of their surgery. The resulting photographs were subject to panel cosmetic assessment. A patient-reported cosmetic outcome questionnaire and the body image scale (BIS) were administered to each woman at a single time point to coincide with the anniversary of their surgery. Multilevel linear regression modelling was used to analyse the results.

Results

Seventy-three women underwent 53 implant-assisted LD breast reconstructions and 20 autologous procedures with a mean follow-up of 2.71 years. The incidence of radiotherapy in this cohort was 43%. RT over time adversely influenced overall cosmetic outcome as assessed by the panel (P = 0.0002), and BRA (P = 0.033), both of which were significantly worse in the implant-assisted group (P = 0.020). Patient reporting of overall cosmetic outcome and BIS, however, did not differ significantly between the LD groups or following RT.

Conclusion

Radiotherapy may adversely affect the cosmetic outcome of latissimus dorsi breast reconstruction, particularly if an implant is used, but this is not universal. Patient assessment of their cosmetic outcome may, however, differ significantly from the clinician’s view.
Appendix
Available only for authorised users
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Metadata
Title
A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy
Authors
Helen Jane Thomson, MBChB
Shelley Potter, MBChB (Hons)
Rosemary Jane Greenwood, MSc.
Amit Bahl, MD
Jane Barker, RGN
Simon John Cawthorn, MS
Zoë Ellen Winters, PhD
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9772-2

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