Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation.
BACKGROUND
This study reports the rate of breast reconstruction failure and cosmetic outcomes after postmastectomy radiation therapy (PMRT) with temporary tissue expanders (TEs) or implants in place.


METHODS
Ninety-four patients underwent mastectomy (93 unilateral, 1 bilateral; 95 cases total) and immediate TE reconstruction followed by PMRT. Ninety TEs and 5 permanent implants were irradiated. All patients received a dose of 5400 cGy given in 180-cGy fractions to the reconstructed breast. Twenty-one patients (22%) received tangents alone and 74 patients (78%) were treated with tangents and a supraclavicular field using a monoisocentric technique. Bolus was used in 91 patients (96%). Eighty-eight patients (93%) received chemotherapy and 78 patients (82%) received endocrine therapy.


RESULTS
With a median follow-up of 24.1 months, 19 patients (20%) experienced failure of reconstruction. The 1-, 2-, and 3-year actuarial rate of reconstruction failure was 9.7%, 19.3%, and 25.5%, respectively. Infection was the most common cause of failure. Of the 19 failures, 8 patients underwent salvage procedures with flap reconstruction. Univariate analysis was performed examining age, chemotherapy use, hormone therapy use, use of a supraclavicular field, smoking status, diabetes, hypertension, and menopausal status. No risk factors were found to be associated with reconstruction failure. In patients who did not experience reconstruction failure, good/excellent cosmesis was observed in 75% of patients.


CONCLUSIONS
In the current series of women with a high risk of locoregional recurrence, PMRT with a TE/implant in place provides good cosmesis in the majority of women, with an acceptable risk of expander or implant loss.
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, USA.
Andrew M
AM
Baschnagel
Chirag
C
Shah
J Ben
JB
Wilkinson
Nayana
N
Dekhne
Douglas W
DW
Arthur
Frank A
FA
Vicini
D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000534:rehabilitation / Q000601:surgery*; D002277:Carcinoma / Q000532:radiotherapy* / Q000534:rehabilitation / Q000601:surgery*; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D015625:Tissue Expansion Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D017211:Treatment Failure