Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making.
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.
Christante
Dara
D
Oregon Health & Science University, Division of Surgical Oncology, Department of Surgery, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Pommier
SuEllen J
SJ
Diggs
Brian S
BS
Samuelson
Bethany T
BT
Truong
AiLien
A
Marquez
Carol
C
Hansen
Juliana
J
Naik
Arpana M
AM
Vetto
John T
JT
Pommier
Rodney F
RF
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