title: Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France. talleta@marseille.fnclcc.fr
authors.forename: Agnès V
authors.initials: AV
authors.lastname: Tallet
authors.forename: Naji
authors.initials: N
authors.lastname: Salem
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Pascal
authors.initials: P
authors.lastname: Ananian
authors.forename: Anne-Chantal
authors.initials: AC
authors.lastname: Braud
authors.forename: Remy
authors.initials: R
authors.lastname: Zalta
authors.forename: Didier
authors.initials: D
authors.lastname: Cowen
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
mesh_terms: 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