title: Postmastectomy breast reconstruction after previous lumpectomy and radiation therapy: analysis of complications and satisfaction.
abstract: BACKGROUND
  Lumpectomy and radiation therapy (breast conservation therapy [BCT]) are common treatments for early-stage breast cancer. However, many of these patients will require a subsequent salvage mastectomy and reconstruction after a locoregional recurrence. This study examines whether prior BCT leads to higher rates of complications and dissatisfaction with subsequent mastectomy and breast reconstruction.
  
  
  METHODS
  All women undergoing initial breast reconstruction at an academic institution were identified (1999-2006). Women who had undergone prior BCT were compared with women without prior BCT. A questionnaire adapted from the Michigan Breast Reconstruction Outcomes Survey was administered. Rates of complications, as well as general and aesthetic satisfaction, were compared between the 2 groups. Multiple logistic regression was used to analyze the effects of prior BCT, age, comorbidities, reconstruction type, and time between radiation and reconstruction.
  
  
  RESULTS
  Overall, 532 women underwent 802 reconstructions, of whom 113 women (137 reconstructions) had prior BCT. Prior BCT did not correlate with higher complication rates (odds ratio [OR] = 1.09, P = 0.690), or lower general or aesthetic satisfaction (OR = 0.84, P = 0.559; OR = 0.91, P = 0.723, respectively); however, there was an increased rate of mastectomy skin flap loss (12.4% vs. 6.8%, P = 0.024). Increasing age was the most significant risk factor for complications and dissatisfaction.
  
  
  CONCLUSIONS
  Radiation in the setting of BCT did not increase overall rates of complications or dissatisfaction with subsequent breast reconstruction in our patient population. These patients, however, had a higher incidence of mastectomy skin flap loss. These findings are important for preoperative counseling and intraoperative planning in patients with prior lumpectomy and radiation.
authors: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors: Ibrahim
authors: I
authors: Khansa
authors: Salih
authors: S
authors: Colakoglu
authors: Michael S
authors: MS
authors: Curtis
authors: Janet H
authors: JH
authors: Yueh
authors: Adeyemi
authors: A
authors: Ogunleye
authors: Adam M
authors: AM
authors: Tobias
authors: Bernard T
authors: BT
authors: Lee
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology