title: Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making.
abstract: OBJECTIVE
  To identify factors independently associated with surgical complications in oncologic and reconstructive surgery and to examine sentinel lymph node (SLN) biopsy data, along with variables that are typically known prior to definitive resection, for their ability to impact the prediction of need for postmastectomy irradiation (PMRT).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Mastectomy patients with stage I to III breast cancer treated in 2000 to 2008.
  
  
  METHODS
  Complication rates of oncologic and reconstructive surgery requiring reoperation and clinicopathologic variables that independently predict complications and/or PMRT administration by multivariate analysis.
  
  
  RESULTS
  Among 100 of 302 mastectomy patients who underwent PMRT, complications occurred in 44% who underwent immediate breast reconstruction (IBR) and 7% who did not (P < .001). Postmastectomy irradiation independently predicted the occurrence of a complication (odds ratio, 3.3; P < .001). Implants were removed in 31% of patients who underwent PMRT and 6% of patients who did not (P = .005). Three percent of patients with T2 or smaller tumors and zero positive SLN required PMRT. Among those with T2 tumors, 49% with a positive axilla lymph node underwent PMRT. Independent predictors of PMRT need were T2 vs T1 tumors, positive axillary lymph node status, and the number of positive SLNs, with odds ratios of 5.8 (P < .001), 14.5 (P < .001), and 2.1 (P = .001), respectively.
  
  
  CONCLUSIONS
  Postmastectomy irradiation was associated with a high rate of surgical complications and implant loss among patients who underwent IBR. Determining the number of positive SLNs prior to definitive resection and reconstructive operations may reduce complications and implant loss by guiding surgical decision making. Patients with a negative SLN are unlikely to require PMRT. Those with positive SLN(s) are high-risk IBR candidates with a quantifiable PMRT risk.
authors.affiliation: Oregon Health & Science University, Division of Surgical Oncology, Department of Surgery, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Christante
authors.forename: SuEllen J
authors.initials: SJ
authors.lastname: Pommier
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Bethany T
authors.initials: BT
authors.lastname: Samuelson
authors.forename: AiLien
authors.initials: A
authors.lastname: Truong
authors.forename: Carol
authors.initials: C
authors.lastname: Marquez
authors.forename: Juliana
authors.initials: J
authors.lastname: Hansen
authors.forename: Arpana M
authors.initials: AM
authors.lastname: Naik
authors.forename: John T
authors.initials: JT
authors.lastname: Vetto
authors.forename: Rodney F
authors.initials: RF
authors.lastname: Pommier
mesh_terms: D000328:Adult; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012907:Smoking / Q000453:epidemiology; D035441:Thoracic Wall / Q000473:pathology; D013997:Time Factors; D015625:Tissue Expansion Devices