Irradiated autologous breast reconstructions: effects of patient factors and treatment variables.
BACKGROUND
Postmastectomy irradiation often negatively impacts breast reconstruction outcomes. Further investigation is necessary to recognize factors contributing to adverse results. The purpose of this study was to (1) accurately assess the impact of radiation on autologous breast reconstruction and (2) identify patient and treatment factors affecting reconstructive outcomes.


METHODS
One hundred twenty-six patients were considered after postmastectomy breast reconstruction and irradiation. The records of 76 patients were studied after excluding for radiation therapy before reconstruction, complications before irradiation, implant reconstruction, mastectomy for recurrent disease, and history of cancer. Patient demographics and comorbidities, operative details, adjuvant therapy, and treatment outcomes were assessed.


RESULTS
Seventy-six patients underwent autologous microsurgical breast reconstruction. Complications occurred in 53 patients (70 percent) 7.2 +/- 6 months after irradiation; 36 cases (47 percent) required reoperation for postirradiation effects. Parenchymal complications (fat necrosis or parenchymal fibrosis) were noted in 19.7 percent, skin complications (tissue envelope retraction or hypertrophic scarring) were recorded in 30.3 percent, and general dissatisfaction (physician or patient dissatisfaction) arose in 27.6 percent of patients. Parenchymal complications were associated with smoking (odds ratio, 9.3; p = 0.03), type II diabetes mellitus (odds ratio, 8.5; p = 0.02), and age (odds ratio, 1.1; p = 0.02). Neoadjuvant chemotherapy increased the development of complications (odds ratio, 4.4; p = 0.04), particularly skin changes (odds ratio, 2.4; p = 0.01).


CONCLUSIONS
Patient-specific factors, including diabetes mellitus and smoking, increase the risk of postirradiation parenchymal changes, and neoadjuvant chemotherapy is associated with a greater than twofold increase in skin complications. Breast reconstruction followed by irradiation can be successful, but patients with specific risks should be aware of increased complication rates.
Albino
Frank P
FP
Rochester, N.Y. From the Division of Plastic Surgery and the Department of Radiation Oncology, University of Rochester Medical Center.
Koltz
Peter F
PF
Ling
Marilyn N
MN
Langstein
Howard N
HN
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005218:Fat Necrosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000528:radiation effects / Q000637:transplantation*; D020360:Neoadjuvant Therapy; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D000970:Antineoplastic Agents