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Cirugía Plástica Ibero-Latinoamericana

On-line version ISSN 1989-2055Print version ISSN 0376-7892


FUERTES-BIELSA, Víctor; FRANCES-MONASTERIO, Mónica  and  FERNANDEZ-PALACIOS, Javier. Two steps prosthesis-based immediate breast reconstruction: is it better to irradiate the tissue-expander or the permanent prosthesis? Bibliographic review and meta-analysis. Cir. plást. iberolatinoam. [online]. 2017, vol.43, n.4, pp.341-349. ISSN 1989-2055.

Background and Objective:

Two steps prosthesis-based immediate breast reconstruction remains a regular procedure.

Our article will attempt to demonstrate if it is better to irradiate the tissue-expander or the permanent prosthesis.


We searched at PUBMED the following main terms: breast reconstruction and implant-based and radiotherapy from January 2010 to January 2016. From the 93 initial results, we selected 30 for abstract reading and 9 of them for a complete reading. We accomplished a critical review of all of them and also a meta-analysis of a 2.157 reconstructions cohort extracted from 4 of those articles.


We developed 2 charts analyzing 4 main categories: A. Reconstructive failure rate; B. Capsular contracture rate; C. Aesthetic results from surgeon perspective: D. Patient satisfaction data. For category A, we also decided to do a meta-analysis of data from 4 articles. We calculated the weighted mean of the Odds Ratio (tissue expander irradiation /prosthesis irradiation).The results were 2.6, CI 95% (1.57-4.29) (fixed effect model) and 2.71 CI 95%(0.95-7.73) if we use random one.

For category B, all of the articles selected concluded a higher capsular contracture rate for the schedule wich irradiates the permanent prosthesis. The results were statistically significant.


From the critical review of the articles we can conclude a higher reconstructive failure rate in the schedule irradiating the tissue expander. The rate of patients suffering capsular contracture seems to be higher if we irradiate the prosthesis. We were not able to obtain clear evidence about which one is achieving better aesthetic results. The use of radiotherapy in combination with this kind of breast reconstruction does not affect patient satisfaction

Keywords : Breast reconstruction; Tissue expander; Mammary prosthesis; Breast radiotherapy; Capsular contracture; Meta-analysis.

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