Outcome of breast implant replacement after radiation therapy: A single-centre retrospective comparative study

Background Implant-based breast reconstruction is a common procedure after mastectomy; however, postoperative radiotherapy (RT) increases the risk of developing complications such as capsular contracture, infection and implant failure. We aimed to compare the outcomes of implant replacement in irradiated versus non-irradiated patients and identify risk factors associated with complications in the RT group. Methods This retrospective study included 83 women who underwent implant replacement after two-stage implant-based reconstruction between 2009 and 2021. Patients were stratified into RT (n=23) and No-RT (n=60) groups. Outcomes assessed included timing of implant replacement, surgical complications, implant failure and need for secondary autologous reconstruction. BREAST-Q patient-reported outcomes were collected at the follow-up. Logistic regression analyses were conducted to identify independent risk factors for complications in RT patients. Results Implant replacement occurred most frequently within 10 years of the initial reconstruction in the RT group compared to the No-RT group (6.1±5.7 years vs 10.5±5.5 years, P =0.001). Capsular contracture was the most frequent indication for implant replacement and was significantly higher in the RT group ( P =0.002). RT patients received smaller implants ( P =0.001) and underwent adjunctive lipofilling more frequently ( P =0.018). Overall postoperative complication rates were significantly higher among the irradiated patients (47.8% vs 18.3, P =0.010). Multivariate logistic regression confirmed BMI [OR:1.51 (95% CI:1.03–2.215, P =0.034) and adjuvant chemotherapy [OR:13.611 (95% CI: 1.127–164.33, P =0.04) as independent predictors of postoperative complications. The BREAST-Q scores were significantly lower in irradiated patients across multiple domains ( P <0.05). Conclusions Implant replacement after RT is associated with increased complications, reconstructive failure and reduced patient satisfaction. Careful patient selection is essential, and autologous reconstruction should be considered when feasible.