Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction.
OBJECTIVE
To determine the long-term complication rates and cosmetic results for patients undergoing postmastectomy radiation therapy (PMRT) after immediate reconstruction (IR).


METHODS
Between January 1998 and December 2005, 92 patients underwent modified radical mastectomy, IR, and PMRT in our practice. A total of 69 patients underwent tissue expander and implant reconstruction (TE/I), and 23 underwent autologous tissue reconstruction (ATR). Follow-up regarding complications and cosmesis was obtained for all 92 patients. Complications were scored as follows: Grade 1, no discomfort; Grade 2, discomfort affecting activities of daily living; Grade 3, surgical intervention or intravenous antibiotics required; and Grade 4, removal or replacement of the reconstruction. Cosmesis was rated as either acceptable or unacceptable to the patient. Both complications and cosmesis were correlated with treatment- and patient-related factors.


RESULTS
Median follow-up for all patients was 38 months. The overall rate of severe complications (Grade 3-4) was 25%. The overall rate of poor functional results (Grade 2-4) was 43.4%. When analyzed as a function of type of reconstruction, the rate of Grade 3 to 4 complications was 33.3% for TE/I vs. 0% for ATR (p = 0.001). The rate of Grade 2 to 4 complications was 55% for TE/I vs. 8.7% for ATR (p < 0.001). Acceptable cosmesis was reported in 51% of TE/I patients vs. 82.6% of ATR patients (p = 0.007). No other treatment or patient-related factors had a significant impact on either complications or cosmesis.


CONCLUSIONS
In patients undergoing PMRT after IR, ATR is associated with fewer long-term complications and better cosmetic results than TE/I.
Jhaveri
Jigna Desai
JD
Department of Radiation Oncology, Long Island Radiation Therapy, Garden City, NY.
Rush
Stephen C
SC
Kostroff
Karen
K
Derisi
Dwight
D
Farber
Leonard A
LA
Maurer
Virginia E
VE
Bosworth
Jay L
JL
D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology; D019736:Prostheses and Implants; D012189:Retrospective Studies; D015625:Tissue Expansion Devices; D014182:Transplantation, Autologous; D016896:Treatment Outcome