Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results.
OBJECTIVE
To report complications, failure rate, and esthetic results in patients undergoing immediate breast reconstruction with a tissue expander and implant, with or without adjuvant treatment.


METHODS
We reviewed the records of the 77 patients who underwent immediate breast reconstruction with an expander/implant between January 1999 and December 2000. Complications were assessed using the Common Toxicity Criteria, version 2, scale. Esthetic results were assessed by the physician using five criteria.


RESULTS
Of the 77 patients, 55 had received adjuvant radiotherapy. The median follow-up was 25 months. Complications appeared to correlate with radiotherapy (14% for nonirradiated patients; 51% for irradiated patients; p = 0.006) and adjuvant chemotherapy (54% with chemotherapy [CHT] vs. 25% without CHT; p = 0.02). Breast reconstruction failed in 21% of patients (9% of nonirradiated patients and 24% of irradiated patients; p = 0.1), and chemotherapy was associated with a worse rate of failure (34% with CHT vs. 6% without CHT, p = 0.005). Adjuvant tamoxifen, however, correlated neither with complications (45% with tamoxifen vs. 39% without; p = 0.15) nor with failure (21% with tamoxifen and 23% without, p = 0.79). Esthetic results were acceptable in 60% of cases.


CONCLUSIONS
Immediate breast reconstruction with an expander/implant can be considered even for patients requiring adjuvant treatment. However, the complication and failure rates are three times higher after postexpander radiotherapy.
Tallet
Agnès V
AV
Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France. talleta@marseille.fnclcc.fr
Salem
Naji
N
Moutardier
Vincent
V
Ananian
Pascal
P
Braud
Anne-Chantal
AC
Zalta
Remy
R
Cowen
Didier
D
Houvenaeghel
Gilles
G
D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D011475:Prosthesis Failure; D011788:Quality of Life; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000009:adverse effects / Q000379:methods; D015625:Tissue Expansion Devices / Q000009:adverse effects; D017211:Treatment Failure