title: Immediate tissue expander/implast breast reconstruction after salvage mastectomy for cancer recurrence following lumpectomy/irradiation.
abstract: BACKGROUND
  The objective of this study was to analyze early complications and long-term outcomes in patients undergoing salvage mastectomy and immediate tissue expander/implant reconstruction for cancer recurrence following breast conservation therapy (lumpectomy/irradiation).
  
  
  METHODS
  A review of all tissue expander/implant reconstructions performed by a single surgeon over an 11-year period from 1997 to 2008 was performed. Two patient cohorts were identified: (1) patients who underwent salvage mastectomy for a cancer recurrence following prior breast conservation therapy, and (2) patients who underwent primary mastectomy without a history of prior irradiation. The incidence of early complications and long-term outcomes were determined for each cohort.
  
  
  RESULTS
  Immediate, tissue expander/implant reconstruction was initiated in 1699 patients. One hundred twenty-one patients had a history of breast conservation therapy (lumpectomy/irradiation), and 1578 did not have a history of prior irradiation. The incidence of early complications was significantly higher in the irradiated cohort compared with that in the nonirradiated cohort (29.7 percent versus 15.5 percent; p ≤ 0.001). The most common complication in both groups was mastectomy flap necrosis (18.0 percent in the irradiated group and 7.7 percent in the nonirradiated group; p < 0.001). Six hundred ninety-seven patients had long-term follow-up data available. Most previously irradiated patients had good or very good results, whereas most nonirradiated patients had excellent results (p = 0.04; Mann-Whitney U test).
  
  
  CONCLUSIONS
  Carefully selected patients who have had prior breast conservation therapy who require salvage mastectomy can successfully complete postmastectomy tissue expander/implant reconstruction. The rate of early complications in this patient group is higher than in the nonirradiated cohort but remains acceptable.
  
  
  METHODS
  Risk, II.
authors.affiliation: New York, N.Y. From Memorial Sloan-Kettering Cancer Center.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Laura
authors.initials: L
authors.lastname: Snell
authors.forename: Alexandra
authors.initials: A
authors.lastname: Heerdt
authors.forename: Colleen
authors.initials: C
authors.lastname: McCarthy
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011446:Prospective Studies; D016879:Salvage Therapy; D013997:Time Factors; D015625:Tissue Expansion Devices