Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Aesthetic Plastic Surgery

Open Access 24-04-2024 | Mastopexy | Review

Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis

Authors: George Pappas, William Karantanis, Femi E. Ayeni, Senarath Edirimanne

Published in: Aesthetic Plastic Surgery

Login to get access

Abstract

Background

Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients.
A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy.

Methods

Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1.

Results

Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39–60), and median time since radiotherapy was 48 months (range 11.7–86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96–6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85–5.35, p-value 0.10) compared to the NIB, but not significant.

Conclusion

We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.​springer.​com/​00266.
Appendix
Available only for authorised users
Literature
1.
Paci E (2012) Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet. J Med Screen 19(1):5–13PubMedCrossRef
2.
Newman LA, Kuerer HM (2005) Advances in breast conservation therapy. J Clin Oncol 23(8):1685–1697PubMedCrossRef
3.
4.
Christiansen D, Kazmier FR, Puckett CL (2008) Safety and aesthetic improvement using the omega pattern reduction mammaplasty after breast conservation surgery and radiation therapy. Plast Reconstr Surg 121(2):374–380PubMedCrossRef
5.
Bajaj AK, Kon PS, Oberg KC, Miles DA (2004) Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg 114(6):1442–1449PubMedCrossRef
6.
Matory WE Jr, Wertheimer M, Fitzgerald T, Walton RL, Love S, Matory WE (1990) Aesthetic results following partial mastectomy and radiation therapy. Plast Reconstr Surg 85(5):739–746PubMedCrossRef
7.
Cocquyt VF, Blondeel PN, Depypere HT, Van De Sijpe KA, Daems KK, Monstrey SJ, Van Belle SJ (2003) Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment. Br J Plast Surg 56(5):462–470PubMedCrossRef
8.
Gray JR, McCormick B, Cox L, Yahalom J (1991) Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys 21(2):347–354PubMedCrossRef
9.
Spector JA, Karp NS (2007) Reduction mammaplasty: a significant improvement at any size. Plast Reconstr Surg 120(4):845–850PubMedCrossRef
10.
O’Blenes CA, Delbridge CL, Miller BJ, Pantelis A, Morris SF (2006) Prospective study of outcomes after reduction mammaplasty: long-term follow-up. Plast Reconstr Surg 117(2):351–358PubMedCrossRef
11.
Archambeau JO, Pezner R, Wasserman T (1995) Pathophysiology of irradiated skin and breast. Int J Radiat Oncol Biol Phys 31(5):1171–1185PubMedCrossRef
12.
Barker HE, Paget JT, Khan AA, Harrington KJ (2015) The tumour microenvironment after radiotherapy: mechanisms of resistance and recurrence. Nat Rev Cancer 15(7):409–425PubMedPubMedCentralCrossRef
13.
Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4(9):529–536PubMedCrossRef
14.
Zhang M-X, Chen C-Y, Fang Q-Q, Xu J-H, Wang X-F, Shi B-H, Wu L-H, Tan W-Q (2016) Risk factors for complications after reduction mammoplasty: a meta-analysis. PLoS ONE 11(12):e0167746PubMedPubMedCentralCrossRef
15.
Handel N, Lewinsky B, Waisman JR (1992) Reduction mammaplasty following radiation therapy for breast cancer. Plast Reconstr Surg 89(5):953–955PubMedCrossRef
16.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906PubMedCrossRef
17.
Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, De Santibañes E, Pekolj J, Slankamenac K, Bassi C (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196PubMedCrossRef
18.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716PubMedCrossRef
19.
Parrett BM, Schook C, Morris D (2010) Breast reduction in the irradiated breast: evidence for the role of breast reduction at the time of lumpectomy. Breast J 16(5):498–502PubMedCrossRef
20.
Moore GH, Schiller JE, Moore GK (2004) Radiation-induced histopathologic changes of the breast: the effects of time. Am J Surg Pathol 28(1):47–53PubMedCrossRef
21.
Ng W (2003) Radiation-associated changes in tissues and tumours. Diagn Pathol 9(2):124–136
22.
Tuncer S, Bello-Rojas G, Ratiu C, Jackson IT (2006) Reduction mammaplasty in the previously radiated breast: is it safe and does it interfere oncologically? Eur J Plast Surg 28:412–417CrossRef
23.
Kronowitz SJ, Hunt KK, Kuerer HM, Strom EA, Buchholz TA, Ensor JE, Koutz CA, Robb GL (2007) Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg 120(7):1755–1768PubMedCrossRef
24.
Hopewell J, Calvo W, Jaenke R, Reinhold H, Robbins M, Whitehouse E (1993) Microvasculature and radiation damage. Acute and long-term side-effects of radiotherapy: biological basis and clinical relevance. Springer, Berlin, pp 1–16CrossRef
25.
Rudolph R, Arganese T, Woodward M (1982) The ultrastructure and etiology of chronic radiotherapy damage in human skin. Ann Plast Surg 9(4):282–292PubMedCrossRef
26.
Yarnold J, Brotons M-CV (2010) Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol 97(1):149–161PubMedCrossRef
27.
Rudolph R (2009) Radiation diminishes stem cell function but does not cause ischemia. Plast Reconstr Surg 124(1):343PubMedCrossRef
28.
Rudolph R (2015) Avoiding tension of wound closure in reduction mammaplasty and mastopexy in previously irradiated breasts. Aesthet Surg J 35(1):NP11–NP12PubMedCrossRef
29.
Munhoz AM, Aldrighi CM, Montag E, Arruda E, Brasil JA, Filassi JR, Aldrighi JM, Gemperli R, Ferreira MC (2011) Outcome analysis of immediate and delayed conservative breast surgery reconstruction with mastopexy and reduction mammaplasty techniques. Ann Plast Surg 67(3):220–225PubMedCrossRef
30.
31.
Asgeirsson K, Rasheed T, McCulley S, Macmillan R (2005) Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol 31(8):817–823PubMedCrossRef
32.
Spear SL, Burke JB, Forman D, Zuurbier RA, Berg CD (1998) Experience with reduction mammaplasty following breast conservation surgery and radiation therapy. Plast Reconstr Surg 102(6):1913–1916PubMedCrossRef
33.
Chin MS, Brooks GS, Stueber K, Hadaegh A, Griggs J, Johnson MA (2009) Asymmetry correction in the irradiated breast: outcomes of reduction mammaplasty and mastopexy after breast-conserving therapy. Aesthet Surg J 29(2):106–112PubMedCrossRef
34.
Patel KM, Hannan CM, Gatti ME, Nahabedian MY (2011) A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty [outcomes article]. Plast Reconstr Surg 127(6):2167–2175PubMedCrossRef
35.
Caruso F, Catanuto G, De Meo L, Ferrara M, Gallodoro A, Petrolito E, Trombetta G, Castiglione G (2008) Outcomes of bilateral mammoplasty for early stage breast cancer. Eur J Surg Oncol 34(10):1143–1147PubMedCrossRef
36.
Weichman KE, Urbinelli L, Disa JJ, Mehrara BJ (2015) Breast reduction in patients with prior breast irradiation: outcomes using a central mound technique. Plast Reconstr Surg 135(5):1276–1282PubMedCrossRef
37.
Lorentzen AK, Lock-Andersen J, Matthiessen LW, Klausen TW, Hölmich LR (2021) Reduction mammoplasty and mastopexy in the previously irradiated breast–a systematic review and meta-analysis. J Plast Surg Hand Surg 55(6):330–338PubMedCrossRef
38.
Sterodimas A, Vargas A, Radwanski H, Pitanguy I (2008) The use of buflomedil in reduction mammaplasty for a previously irradiated breast: a case report. Aesthet Plast Surg 32:383–385CrossRef
39.
Snyder SM, Beshlian KM, Hampson NB (2010) Hyperbaric oxygen and reduction mammaplasty in the previously irradiated breast. Plast Reconstr Surg 125(6):255e–257ePubMedCrossRef
40.
Prasidha I, Boyages J, Lam TC (2023) Safety of reduction mammaplasty and mastopexy after breast conservation therapy and radiation therapy: a case series. Ann Plast Surg 90(1):27–32PubMedCrossRef
41.
Winter R, Haug I, Lebo P, Grohmann M, Reischies FM, Cambiaso-Daniel J, Tuca A, Rienmüller T, Friedl H, Spendel S (2017) Standardizing the complication rate after breast reduction using the Clavien-Dindo classification. Surgery 161(5):1430–1435PubMedCrossRef
42.
Albrecht J, Meves A, Bigby M (2005) Case reports and case series from Lancet had significant impact on medical literature. J Clin Epidemiol 58(12):1227–1232PubMedCrossRef
43.
Cin AD, Knight C, Whelan KF, Farrokhyar F (2012) Bilateral reduction mammoplasty following breast cancer: a case-control study. Can J Plast Surg 20(1):6–9CrossRef
44.
Barnea Y, Bracha G, Arad E, Gur E, Inbal A (2019) Breast reduction and mastopexy for repair of asymmetry after breast conservation therapy: lessons learned. Aesthet Plast Surg 43:600–607CrossRef
45.
Spear SL, Rao SS, Patel KM, Nahabedian MY (2014) Reduction mammaplasty and mastopexy in previously irradiated breasts. Aesthet Surg J 34(1):74–78PubMedCrossRef
Metadata
Title
Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis
Authors
George Pappas
William Karantanis
Femi E. Ayeni
Senarath Edirimanne
Publication date
24-04-2024
Publisher
Springer US
Published in
Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-024-04038-6