763 De-Escalation of Axillary Treatment. Have We Fully Explored the Options for Those Patients Who Undergo Primary Reconstruction with Implants?

Aim

Treatment of the malignant axilla is a contentious area within breast cancer management. The POsitive Sentinel Node (POSNOC) Trial represents one of the largest trials into axillary treatment for the malignant axilla and includes surgical clearance of the axilla (ANC) or axillary radiotherapy (ART).

Patients who undergo primary reconstruction with implants are not excluded from the POSNOC Trial. Yet, data surrounding the risks of axillary radiotherapy to patients with breast implants is scarce. This project aimed to collect and analyse the data of those Trust patients who had undergone immediate reconstruction with an implant and axillary radiotherapy, to review any potential complications, increased risks, and impact on decision-making.

Method

Retrospective study, looking at the five years of data (2017-2022).

Results

21 patients were identified as having breast implants with axillary node metastasis. Of these, eight patients had axillary treatment due to macro-metastasis. Five of these patients had ANC and the remaining three patients had axillary radiotherapy. Out of these patients one patient (33%) had to have their implant removed post radiotherapy, due to capsular contracture. Within the limitations of this small study, we can see that in patients with primary implant reconstruction are more likely to have ANC rather than radiotherapy. Additionally, in three patients with implants 33% had complications that could be related to radiotherapy.

Conclusions

Further research into the impact of axillary radiotherapy in patients with implants is vital, so that patients can be adequately informed to make decisions about their treatment options.