title: Postmastectomy chest wall radiation to a temporary tissue expander or permanent breast implant--is there a difference in complication rates?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the likelihood of complications and cosmetic results among breast cancer patients who underwent modified radical mastectomy (MRM) and breast reconstruction followed by radiation therapy (RT) to either a temporary tissue expander (TTE) or permanent breast implant (PI).
  
  
  METHODS
  Records were reviewed of 74 patients with breast cancer who underwent MRM followed by breast reconstruction and RT. Reconstruction consisted of a TTE usually followed by exchange to a PI. RT was delivered to the TTE in 62 patients and to the PI in 12 patients. Dose to the reconstructed chest wall was 50 Gy. Median follow-up was 48 months. The primary end point was the incidence of complications involving the reconstruction.
  
  
  RESULTS
  There was no significant difference in the rate of major complications in the PI group (0%) vs. 4.8% in the TTE group. No patients lost the reconstruction in the PI group. Three patients lost the reconstruction in the TTE group. There were excellent/good cosmetic scores in 90% of the TTE group and 80% of the PI group (p = 0.22). On multivariate regression models, the type of reconstruction irradiated had no statistically significant impact on complication rates.
  
  
  CONCLUSIONS
  Patients treated with breast reconstruction and RT can experience low rates of major complications. We demonstrate no significant difference in the overall rate of major or minor complications between the TTE and PI groups. Postmastectomy RT to either the TTE or the PI should be considered as acceptable treatment options in all eligible patients.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Penny R
authors.initials: PR
authors.lastname: Anderson
authors.forename: Gary
authors.initials: G
authors.lastname: Freedman
authors.forename: Nicos
authors.initials: N
authors.lastname: Nicolaou
authors.forename: Navesh
authors.initials: N
authors.lastname: Sharma
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.forename: Neal
authors.initials: N
authors.lastname: Topham
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015411:Mastectomy, Modified Radical / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000528:radiation effects; D015625:Tissue Expansion Devices; D016896:Treatment Outcome