title: Impact of sequencing of postmastectomy radiotherapy and breast reconstruction on timing and rate of complications and patient satisfaction.
abstract: OBJECTIVE
  There are few long-term studies of how the sequencing of postmastectomy radiotherapy (PMRT) and breast reconstruction (BR) affects the time to development of complications or patient satisfaction with BR. We therefore studied this issue.
  
  
  METHODS
  One hundred thirteen women who underwent BR at Beth Israel Deaconess Medical Center (Boston, MA) from 1999-2006 and also received PMRT were included. Complications requiring surgery were categorized as early (within 90 days of BR) or late. The median length of follow-up after BR was 46.5 months. Patients' general and esthetic satisfaction was assessed with a validated questionnaire.
  
  
  RESULTS
  Complications occurred among 32% of 57 women receiving PMRT before BR and 44% of 57 patients having BR before PMRT (p = 0.176). Early complications were more frequent in patients who had PMRT first (18%) than for those with BR first (11%) (p = 0.210); conversely, late complication rates in the two groups were 14% and 33%, respectively (p = 0.009). General satisfaction was comparable between the PMRT-first and BR-first groups (68% and 68%, respectively; p = 0.995); esthetic satisfaction rates were also similar (50% and 62%, respectively; p = 0.238).
  
  
  CONCLUSIONS
  The sequencing of PMRT and BR did not have a substantial impact on the total risk of complications or patients' general and esthetic satisfaction. However, early complications tended to develop in patients having PMRT first, whereas patients having BR first had a higher risk of late complications. Additional study of the effects of sequencing of PMRT on particular types of reconstructions may help devise strategies for reducing these risks.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Adesiyun
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Janet H
authors.initials: JH
authors.lastname: Yueh
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.forename: Salih
authors.initials: S
authors.lastname: Colakoglu
authors.forename: Katarina E M
authors.initials: KE
authors.lastname: Anderson
authors.forename: Minh-Doan T
authors.initials: MD
authors.lastname: Nguyen
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D011795:Surveys and Questionnaires