Abstract Background Radiotherapy (RT) is a risk factor for impaired outcomes after implant-based immediate breast reconstruction (IBR). Large studies including long-term follow-up are relatively scarce. The purpose of this analysis was to assess long-term effects of RT in implant-based IBR, distinguishing between implant removal because of postoperative complications versus patient preference. Methods This population-based cohort study included all patients with breast cancer who underwent implant-based IBR in Stockholm between 2005 and 2015. Data were collected through national registers and medical charts. The main endpoint was implant removal owing to postoperative complications (wound breakdown, infection, bleeding) or patient preference (dissatisfaction, pain, capsular contracture), with or without conversion to autologous reconstruction. Results Some 1749 implant-based IBRs in 1687 women were included. Median follow-up was 72 (range 1–198) months. Reconstructions were divided according to receipt of RT: No RT (n = 856, 48.9 per cent), adjuvant RT (n = 749, 42.8 per cent), and previous RT (n = 144, 8.2 per cent). Implant removal occurred after 266 reconstructions (15.2 per cent); 68 (7.9 per cent) in the no RT, 158 (21.1 per cent) in the adjuvant RT, and 40 (27.8 per cent) in the previous RT group. Implant removal was because of postoperative complications in 152 instances (57.1 per cent) and was most common in the first 3 years. This was especially observed in the previous RT group, where 15 of 23 implant removals occurred during the first 6 months. Implant removal owing to patient preference (114 of 266, 42.9 per cent) became more common with increasing follow-up. Conclusion Implant removal after implant-based IBR is significantly associated with RT. The reason for implant removal shifts over time from postoperative complications to patient preference.

中文翻译：

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基于植入物的即刻乳房重建（有或没有放疗）的长期结果：一项基于人群的研究

摘要 背景放射治疗（RT）是基于植入物的即刻乳房重建（IBR）后结果受损的危险因素。包括长期随访的大型研究相对较少。本分析的目的是评估 RT 对基于植入物的 IBR 的长期影响，区分因术后并发症而移除植入物与患者偏好。 方法这项基于人群的队列研究包括 2005 年至 2015 年间在斯德哥尔摩接受基于植入物的 IBR 的所有乳腺癌患者。数据通过国家登记册和医疗图表收集。主要终点是由于术后并发症（伤口破裂、感染、出血）或患者偏好（不满意、疼痛、包膜挛缩）而移除植入物，无论是否转为自体重建。 结果1687 名女性中约有 1749 名基于植入物的 IBR 被纳入其中。中位随访时间为 72（范围 1-198）个月。根据接受 RT 的情况将重建分为：无 RT（n = 856，48.9%）、辅助 RT（n = 749，42.8%）和既往 RT（n = 144，8.2%）。266 次重建（15.2%）后移除了植入物；无 RT 组中有 68 例（7.9%），辅助 RT 组有 158 例（21.1%），先前 RT 组中有 40 例（27.8%）。152 例（57.1%）因术后并发症而移除植入物，并且在前 3 年最为常见。在之前的 RT 组中尤其观察到这一点，其中 23 例种植体移除中有 15 例发生在前 6 个月内。随着随访的增加，由于患者偏好而移除植入物（266 例中有 114 例，占 42.9%）变得更加常见。 结论基于种植体的 IBR 后去除种植体与 RT 显着相关。随着时间的推移，移除植入物的原因从术后并发症转变为患者的偏好。