title: Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy.
abstract: OBJECTIVE
  To compare the rates of complications and patient satisfaction among breast cancer patients treated with mastectomy and tissue expander/implant reconstruction with and without radiotherapy.
  
  
  METHODS
  As part of the Michigan Breast Reconstruction Outcome Study (MBROS), breast cancer patients undergoing mastectomy with reconstruction were prospectively evaluated with respect to complications, general patient satisfaction with reconstruction, and esthetic satisfaction. Included in this study was a cohort of women who underwent breast reconstruction using an expander/implant (E/I). A subset of these patients also received radiotherapy (RT). At 1 and 2 years postoperatively, a survey was administered which included 7 items assessing both general satisfaction with their reconstruction and esthetic satisfaction. Complication data were also obtained at the same time points using hospital chart review. Radiotherapy patients identified in the University of Michigan Radiation Oncology database that underwent expander/implant reconstruction but not enrolled in the MBROS study were also added to the analysis.
  
  
  RESULTS
  Eighty-one patients underwent mastectomy and E/I reconstruction. Nineteen patients received RT and 62 underwent reconstruction without RT. The median dose delivered to the reconstructed breast/chest wall, including boost, was 60.4 Gy (range, 50.0-66.0 Gy) in 1.8- to 2.0-Gy fractions. With a median follow-up of 31 months from the date of surgery, complications occurred in 68% (13/19) of the RT patients compared to 31% (19/62) in the no RT group (p = 0.006). Twelve of 81 patients (15%) had a breast reconstruction failure. Reconstruction failure was significantly associated with experiencing a complication (p = 0.0001) and the use of radiotherapy (p = 0.005). The observed reconstruction failure rates were 37% (7/19) and 8% (5/62) for patients treated with and without radiotherapy, respectively. Tamoxifen was associated with a borderline risk of complications (p = 0.07) and a significant risk of reconstruction failure (p = 0.01). Sixty-six patients of the study group completed the satisfaction survey; 15 patients did not. To offset potential bias for patients not completing the survey, we analyzed satisfaction data assuming "dissatisfaction" scores for surveys not completed. In the analysis of patients with unilateral E/I placement, reconstruction failure was significantly associated with a lower general satisfaction (p = 0.03). Ten percent of patients experiencing a reconstruction failure were generally satisfied compared to 23% who completed E/I reconstruction. In addition, tamoxifen use was associated with a significantly decreased esthetic satisfaction (p = 0.03). Radiotherapy was not associated with significantly decreased general or esthetic satisfaction.
  
  
  CONCLUSIONS
  Irradiated patients had a higher rate of expander/implant reconstruction failure and complications than nonirradiated patients. Despite these differences, our pilot data suggest that both general satisfaction and patient esthetic satisfaction were not significantly different following radiotherapy compared to patients who did not receive RT. Although statistical power was limited in the present study and larger patient numbers are needed to validate these results, this study suggests comparable patient assessment of cosmetic outcome with or without radiotherapy in women who successfully complete expander/implant reconstruction.
authors.affiliation: Department of Radiation Oncology, The University of Michigan Medical School, 1500 East Medical Center Drive, UH-B2C490, Box 0100, Ann Arbor, MI 48109, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Krueger
authors.forename: E G
authors.initials: EG
authors.lastname: Wilkins
authors.forename: M
authors.initials: M
authors.lastname: Strawderman
authors.forename: P
authors.initials: P
authors.lastname: Cederna
authors.forename: S
authors.initials: S
authors.lastname: Goldfarb
authors.forename: F A
authors.initials: FA
authors.lastname: Vicini
authors.forename: L J
authors.initials: LJ
authors.lastname: Pierce
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D018427:Breast Implants; D001943:Breast Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology; D008408:Mastectomy / Q000534:rehabilitation*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011475:Prosthesis Failure; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D013629:Tamoxifen / Q000627:therapeutic use; D015625:Tissue Expansion Devices; D017211:Treatment Failure
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen