title: Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation.
abstract: BACKGROUND
  Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated.
  
  
  METHODS
  Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR.
  
  
  RESULTS
  Median follow-up was 86 months (range, 11-161 months). The 7-year PIRR-free rate was 71% (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1% (21), and removal was 13.3% (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81% and overall survival 93%.
  
  
  CONCLUSIONS
  Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. HoA1234@mskcc.org
authors.forename: Alice
authors.initials: A
authors.lastname: Ho
authors.forename: Peter
authors.initials: P
authors.lastname: Cordeiro
authors.forename: Joseph
authors.initials: J
authors.lastname: Disa
authors.forename: Babak
authors.initials: B
authors.lastname: Mehrara
authors.forename: Jean
authors.initials: J
authors.lastname: Wright
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Van Zee
authors.forename: Clifford
authors.initials: C
authors.lastname: Hudis
authors.forename: Amanda
authors.initials: A
authors.lastname: McLane
authors.forename: Joanne
authors.initials: J
authors.lastname: Chou
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhang
authors.forename: Simon
authors.initials: S
authors.lastname: Powell
authors.forename: Beryl
authors.initials: B
authors.lastname: McCormick
mesh_terms: D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D019233:Retreatment; D015626:Tissue Expansion / Q000379:methods*; D016896:Treatment Outcome