title: Complication rates of radiation on tissue expander and autologous tissue breast reconstruction.
abstract: BACKGROUND
  To evaluate risk factors for complications of tissue expander/implant and autologous tissue breast reconstructions and determine if radiation increases complication rates.
  
  
  METHODS
  We performed a retrospective review of patients who underwent mastectomy plus autologous tissue or expander/implant reconstruction at the Cleveland Clinic. Univariate and multivariate analysis were performed in each group to evaluate for risk factors for complications. A complication was considered major if it required reoperation. A predictive model was used to compare the 2 groups to one another.
  
  
  RESULTS
  A total of 1037 patients were included in the study. In the tissue expander/implant population, there was a total complication rate of 31.8% and overall major complication rate of 24.4%. Radiation increased the major complication rate from 21.2 to 45.4%. However, 70.1% of the radiated patients ultimately had a successful implant-based reconstruction while an additional 10.3% went on to have autologous reconstruction. Age and body mass index (BMI) > 30 also led to higher major complication rates in tissue expander/implant reconstruction while smoking, hypertension, and chemotherapy had no impact. In the autologous reconstruction group, there was a total complication rate of 31.5% and a major complication rate of 19.7%. There was no statistically significant difference between the radiated and nonradiated autologous tissue reconstructions with major complication rates of 17.9 and 20.5%, respectively. BMI > 30 was the only significant factor leading to higher major complications in the autologous reconstructions.
  
  
  CONCLUSIONS
  Total complication rates were similar between tissue expander and autologous reconstructions. Increased major complication rates in patients with tissue expander reconstructions occurred in those with radiation, but was still successful in the majority of patients. Radiation had no influence on autologous tissue reconstruction major complication rates.
authors.affiliation: Women's Health Institute, Breast Surgery, Cleveland Clinic, Cleveland, OH, USA. tberr2@gmail.com
authors.forename: Tiffany
authors.initials: T
authors.lastname: Berry
authors.forename: Suzanne
authors.initials: S
authors.lastname: Brooks
authors.forename: Nicole
authors.initials: N
authors.lastname: Sydow
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.forename: Joanne
authors.initials: J
authors.lastname: Lyons
authors.forename: Jill
authors.initials: J
authors.lastname: Dietz
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015625:Tissue Expansion Devices