[Evaluation of immediate breast reconstruction and radiotherapy: factors associated with complications].
OBJECTIVE
To determine prospectively the factors associated with reconstruction failure (i.e. requiring expander removal) and capsular contracture in patients undergoing mastectomy and immediate two-stage breast reconstruction with a tissue expander and implant, and radiotherapy for breast cancer. This is a multi-institutional prospective nonrandomized trial.


METHODS
Between 2/1998 and 9/2006, we prospectively evaluated 141 consecutive patients who received 141 implants after mastectomy and underwent chest wall radiotherapy (46 to 50 Gy in 23 to 25 fractions). Patients were evaluated after 24 to 36 months by two senior physicians (radiation oncologist and surgeon).


RESULTS
Medical follow-up was 37 months. Baker 1 and 2 capsular contracture was observed in 67.5% of patients, Baker 3 and 4 in 32.5%. There were 32 reconstruction failures. In a univariate analysis, the following factors were associated with Baker 3 and 4 capsular contracture: surgeon, use of hormonotherapy and smoking, of which only one remained in the multivariate analysis: surgeon. In a univariate analysis, the following factors were associated with reconstruction failure: tumor size T3 or T4, smoking, pN+ axilla. Three factors remained associated with reconstruction failure in a multiple logistic regression: large tumors T3/T4, smoking and pN+ axilla.


CONCLUSIONS
Mastectomy, radiotherapy and immediate breast reconstruction with a tissue expander and implant should be considered when breast conserving surgery has been denied. Adequate patients can be easily selected by using three factors of favourable outcome.
Gross
E
E
Département de radiothérapie, hôpital de la Timone, rue Saint-Pierre, 13005 Marseille, France. emmanuel.gross@ap-hm.fr
Hannoun-Levi
J-M
JM
Rouanet
P
P
Houvenaeghel
G
G
Teissier
E
E
Ellis
S
S
Resbeut
M
M
Tallet
A
A
Vaini Cowen
V
V
Azria
D
D
Cowen
D
D
D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D019928:Breast Implantation / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data; D018427:Breast Implants; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D016462:Mammaplasty / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D017211:Treatment Failure; D014945:Wound Healing / Q000187:drug effects / Q000528:radiation effects
D018931:Antineoplastic Agents, Hormonal