Comparison of breast volume change between oncoplastic breast-conserving surgery with radiation therapy and a simultaneous contralateral balancing procedure through the inverted-T scar technique

Background Reduction mammoplasty or mastopexy is performed as an additional balancing procedure in patients with large or ptotic breasts who undergo breast-conserving surgery (BCS). Radiation therapy on breasts that have undergone surgery may result in changes in the volume. This study presents a comparative analysis of patients who received post-BCS balancing procedures to determine whether volume changes were larger in breasts that received radiation therapy than on the contralateral side.

Methods Thirty-six participants were selected among patients who received BCS using the inverted-T scar technique between September 2012 and July 2017, were followed up for 2 or more years, and had pre-radiation therapy computed tomography images and post-radiation therapy images taken between 12 and 18 months after completion. The average age of the participants was 53.5 years, their average body mass index was 26.62 kg/m².

Results The pre- and post-radiation therapy volumes of the breasts receiving BCS were 666.08±147.48 mL and 649.33±130.35 mL, respectively. In the contralateral breasts, the volume before radiation therapy was 637.69±145.72 mL, which decreased to 628.14±166.41 mL after therapy. The volume ratio of the affected to the contralateral breasts was 1.05±0.10 before radiation therapy and 1.06±0.12 after radiation therapy.

Conclusions The ratio of the volume between the two breasts immediately after surgery and at roughly 18 months postoperatively was not significantly different (P=0.98). For these reasons, we recommend a simultaneous single-stage balancing procedure as a reasonable option for patients who require radiation therapy after BCS without concerns regarding volume change.

Keywords

Mammaplasty - Breast reconstruction - Radiotherapy

Publication History

Received: 15 June 2020

Accepted: 13 October 2020

Article published online:
25 March 2022

• REFERENCES

• 1 Smith ML, Clarke-Pearson EM, Vornovitsky M. et al. The efficacy of simultaneous breast reconstruction and contralateral balancing procedures in reducing the need for second stage operations. Arch Plast Surg 2014; 41: 535-41
• 2 Nahabedian MY. Managing the opposite breast: contralateral symmetry procedures. Cancer J 2008; 14: 258-63
• 3 Song WJ, Kang SG, Kim EK. et al. Current status of and trends in post-mastectomy breast reconstruction in Korea. Arch Plast Surg 2020; 47: 118-25
• 4 Nahabedian MY. Symmetrical breast reconstruction: analysis of secondary procedures after reconstruction with implants and autologous tissue. Plast Reconstr Surg 2005; 115: 257-60
• 5 Mukesh M, Harris E, Jena R. et al. Relationship between irradiated breast volume and late normal tissue complications: a systematic review. Radiother Oncol 2012; 104: 1-10
• 6 Panettiere P, Marchetti L, Accorsi D. et al. Aesthetic breast reconstruction. Aesthetic Plast Surg 2002; 26: 429-35
• 7 Spear SL, Ducic I, Low M. et al. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg 2005; 115: 84-95
• 8 Clough KB, Cuminet J, Fitoussi A. et al. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 1998; 41: 471-81
• 9 Park TS, Seo JY, Razzokov AS. et al. Volumetric change of the latissimus dorsi muscle after postoperative radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap. Arch Plast Surg 2020; 47: 135-9
• 10 Du Z, Zhou Y, Chen J. et al. Retrospective observational study of breast reconstruction with extended latissimus dorsi flap following skin-sparing mastectomy. Medicine (Baltimore) 2018; 97: e10936