Risk factors for failure of immediate breast reconstruction with prosthesis after total mastectomy for breast cancer.
BACKGROUND
Immediate breast reconstruction (IBR) after mastectomy represents a clear improvement in the quality of life of patients with breast cancer, but prosthesis removal is relatively frequent. Therefore, it is important to identify risk factors related to this removal.


METHODS
A series of 142 patients treated with mastectomy and IBR at the Institut Gustave-Roussy between January 1976 and December 1988 were studied. Forty-seven had an in situ carcinoma, 93 an infiltrating carcinoma, and 2 a fibrosarcoma. IBR failures were defined as removal of the prosthesis, and early failures as removal during the first 7 weeks after IBR.


RESULTS
The early failure rate was significantly higher in patients with invasive carcinomas or fibrosarcomas than patients with in situ carcinomas (12% versus 0%, P = 0.04). The risk of late IBR failure was significantly higher in patients who had received postoperative radiation therapy than patients who did not (P = 0.0002). However, this increased risk applied only to women in whom the chest wall was exposed to radiation because of a high risk of recurrence.


CONCLUSIONS
It might be preferable to postpone breast reconstruction for patients with infiltrating breast carcinoma because early complications are not infrequent and could delay adjuvant chemotherapy. Late complications associated with chest wall irradiation could be avoided with the use of alternative techniques such as the transverse rectus abdominis myocutaneous (TRAM) flap procedure.
Barreau-Pouhaer
L
L
Department of Surgery, Institut Gustave-Roussy, Villejuif, France.
Lê
M G
MG
Rietjens
M
M
Arriagada
R
R
Contesso
G
G
Martins
R
R
Petit
J Y
JY
D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015411:Mastectomy, Modified Radical; D015413:Mastectomy, Simple; D008875:Middle Aged; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors