University Hospital of Strasbourg Study Compares Immediate and Delayed-Immediate Breast Reconstruction After Mastectomy
When a woman faces a mastectomy due to breast cancer, the journey ahead is a difficult one, and breast reconstruction is part of that process. In France, breast cancer affects approximately one in eight women during their lifetime, and losing a breast can have a profound impact on body image. For this reason, around 30% of women choose reconstruction using implants, their own tissue, or fat transfer.
If a patient needs radiation therapy after surgery, reconstruction should be performed gradually, in two stages. It was thought that radiation could damage the tissue, making it safer to first place a temporary tissue expander and only insert a permanent implant after treatment. However, a new retrospective study published in Annales de Chirurgie Plastique Esthétique suggests that there may be new insights that could make this process easier.
The retrospective study “Immediate breast reconstruction versus delayed-immediate breast reconstruction: A Strasbourg experience retrospective study” was conducted by S. Deltonne, P. Kara, C. Huttin, and F. Bodin from the Department of Plastic, Reconstructive and Aesthetic Surgery at the University Hospital of Strasbourg, Strasbourg, France.
As the study authors explained, the goal of the research was to assess the importance of tissue expanders by comparing immediate breast reconstruction (IBR) with delayed-immediate breast reconstruction (DIBR). This retrospective study included patients who underwent surgery between January 2019 and December 2023. Data were collected from medical records, photographs, and telephone interviews, with researchers examining a wide range of factors, including reconstruction type, complications, body mass index, and smoking status.
“In cases where post-mastectomy radiotherapy is indicated, the aesthetic and functional outcome of the reconstruction can be compromised. Radiotherapy may lead to capsular contracture in implant-based reconstructions, as well as volume loss, fat necrosis, and tissue fibrosis in flaps and fat grafting techniques. To mitigate these effects, delayed-immediate breast reconstruction (DIBR) using a temporary tissue expander has become a widely accepted strategy.” Deltonne S. et al.
By analyzing data from 149 patients (a total of 192 reconstructions), researchers sought to answer a key question: does the additional step of using a tissue expander actually lead to a better aesthetic outcome? When independent surgeons evaluated photographs without knowing which type of reconstruction each patient had undergone, the final appearance of the breasts was comparable between the two groups.
“The main finding of this study is that, among patients who reached the final stage of breast reconstruction, the aesthetic outcome assessed by blinded surgeons was comparable between IBR and DIBR, regardless of the reconstructive technique used. This observation remained consistent even after stratification for radiotherapy exposure, a major confounding factor in breast reconstruction. These results suggest that the potential aesthetic advantage traditionally attributed to tissue expanders in the setting of radiotherapy may be limited once reconstruction has been successfully completed. However, this finding must be interpreted with caution, as the choice of reconstructive strategy was not randomized and was influenced by clinical factors, particularly the anticipated need for radiotherapy.”Deltonne S. et al.
The study confirmed that radiation negatively affected patient satisfaction but did not significantly affect aesthetic evaluations or complication rates between groups. However, while the aesthetic results were similar, the patient experience was very different. The two-stage approach proved to be considerably more demanding. Women in that group underwent an average of 2.3 procedures, while those who had immediate reconstruction typically completed their treatment with an average of 1.6 procedures. Beyond the number of surgeries, there was also the issue of physical discomfort. Patients with temporary tissue expanders reported significantly more chest pain and discomfort.
Hope for a simpler path through reconstruction
For many women, immediate reconstruction could mean a faster return to everyday life, with less pain and without compromising aesthetic results. Although the two-stage approach will likely remain valuable for certain more complex cases, these findings offer hope for a simpler path through reconstruction.
Of course, every study has its limitations; its retrospective and monocentric design introduces a risk of selection and indication bias, as the choice between IBR and DIBR was driven by clinical judgement rather than randomization. Second, only patients who completed their reconstructive process and had available postoperative photographs were included in the aesthetic analysis. As a result, reconstructive failures, conversions to delayed reconstruction, and implant losses were excluded, which may have led to an overestimation of aesthetic outcomes, particularly in higher-risk patients,” they explained. The authors emphasize the need for larger studies to confirm these findings, “including reconstructive failures and longer follow-up are needed to better define the respective roles of IBR and DIBR in the context of radiotherapy.”
Image: Cancer Therapy Advisor
