title: Unilateral preoperative chest wall irradiation in bilateral tissue expander breast reconstruction with acellular dermal matrix: a prospective outcomes analysis.
abstract: BACKGROUND
  Prior breast irradiation increases the rate of postoperative complications, including capsular contracture, in tissue expander/implant reconstruction. Acellular dermal matrix is heralded to decrease capsular contracture, but recent evidence suggests a possible increase in postoperative complications. The authors evaluated outcomes in patients undergoing bilateral tissue expander/implant reconstruction with acellular dermal matrix in the setting of prior unilateral irradiation.
  
  
  METHODS
  A case-control study was conducted on all patients undergoing bilateral, acellular dermal matrix-assisted, tissue expander/implant reconstruction with a history of previous unilateral irradiation at Memorial Sloan-Kettering Cancer Center. Complication rates were compared.
  
  
  RESULTS
  Twenty-three patients met inclusion criteria and had an average follow-up of 19 months (range, 4 to 60 months). The perioperative infection rate was 21.7 percent (n = 5) in irradiated breasts and 4.3 percent (n = 1) in control breasts (p = 0.079). Mastectomy skin flap necrosis, explantation, hematoma, and seroma rates were not significantly different between the groups. Sixty percent of patients had irradiated breast contracture that was one Baker grade greater than that in the nonirradiated breast. Body mass index greater than 25 and smoking history were significant independent risk factors for early postoperative complications in univariate analysis (p = 0.01).
  
  
  CONCLUSIONS
  Previous irradiation does not appear to increase the risk of early postoperative complications associated with acellular dermal matrix use in tissue expander/implant breast reconstruction. However, body mass index greater than 25 and smoking history are cause for caution. In addition, acellular dermal matrix does not appear to affect the degree of capsular contracture formation in the setting of prior irradiation.
  
  
  METHODS
  : Therapeutic, III.
authors: New York, N.Y. From the Department of Plastic Surgery, Memorial Sloan-Kettering Cancer Center, and New York University Medical Center, Institute of Reconstructive Plastic Surgery.
authors: Katie E
authors: KE
authors: Weichman
authors: Yeliz
authors: Y
authors: Cemal
authors: Claudia R
authors: CR
authors: Albornoz
authors: Colleen M
authors: CM
authors: McCarthy
authors: Andrea L
authors: AL
authors: Pusic
authors: Babak J
authors: BJ
authors: Mehrara
authors: Joseph J
authors: JJ
authors: Disa
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D011446:Prospective Studies; D011832:Radiation Injuries / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps / Q000473:pathology; D015625:Tissue Expansion Devices; D016896:Treatment Outcome
references: Harris JR, Halpin-Murphy P, McNeese M, Mendenhall NP, Morrow M, Robert NJ. Consensus Statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys. 1999;44:989–990
references: Recht A, Edge SB, Solin LJ, et al.American Society of Clinical Oncology. Postmastectomy radiotherapy: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1539–1569
references: Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–1461
references: Krueger EA, Wilkins EG, Strawderman M, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys. 2001;49:713–721
references: Persichetti P, Cagli B, Simone P, et al. Implant breast reconstruction after salvage mastectomy in previously irradiated patients. Ann Plast Surg. 2009;62:350–354
references: Ascherman JA, Hanasono MM, Newman MI, Hughes DB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg. 2006;117:359–365
references: Tallet AV, Salem N, Moutardier V, et al. Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: Complications and esthetic results. Int J Radiat Oncol Biol Phys. 2003;57:136–142
references: Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: Current issues. Plast Reconstr Surg. 2004;114:950–960
references: Delanian S, Lefaix JL. The radiation-induced fibroatrophic process: Therapeutic perspective via the antioxidant pathway. Radiother Oncol. 2004;73:119–131
references: Weichman KE, Wilson SC, Weinstein AL, et al. The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction. Plast Reconstr Surg. 2012;129:1049–1058
references: Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg. 2005;55:232–239
references: Salzberg CA. Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm). Ann Plast Surg. 2006;57:1–5
references: Gamboa-Bobadilla GM. Implant breast reconstruction using acellular dermal matrix. Ann Plast Surg. 2006;56:22–25
references: Zienowicz RJ, Karacaoglu E. Implant-based breast reconstruction with allograft. Plast Reconstr Surg. 2007;120:373–381
references: Bindingnavele V, Gaon M, Ota KS, Kulber DA, Lee DJ. Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction. J Plast Reconstr Aesthet Surg. 2007;60:1214–1218
references: Spear SL, Parikh PM, Reisin E, Menon NG. Acellular dermis-assisted breast reconstruction. Aesthetic Plast Surg. 2008;32:418–425
references: Lanier ST, Wang ED, Chen JJ, et al. The effect of acellular dermal matrix use on complication rates in tissue expander/implant breast reconstruction. Ann Plast Surg. 2010;64:674–678
references: Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: Determining the incidence and significant predictors of complications. Plast Reconstr Surg. 2010;125:1606–1614
references: Liu F, Li L, Zhu Y, Yao S, Wang S. Use of allogenic acellular dermal matrix in abdominal wall hernia and defect repair in 31 cases (in Chinese). Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010;24:1253–1256
references: Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: A head-to-head comparison of outcomes. Plast Reconstr Surg. 2009;124:1735–1740
references: Sbitany H, Serletti JM. Acellular dermis-assisted prosthetic breast reconstruction: A systematic and critical review of efficacy and associated morbidity. Plast Reconstr Surg. 2011;128:1162–1169
references: Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128:403e–410e
references: Chun YS, Verma K, Rosen H, et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg. 2010;125:429–436
references: Spear SL, Boehmler JH, Bogue DP, Mafi AA. Options in reconstructing the irradiated breast. Plast Reconstr Surg. 2008;122:379–388
references: McCarthy CM, Pusic AL, Disa JJ, McCormick BL, Montgomery LL, Cordeiro PG. Unilateral postoperative chest wall radiotherapy in bilateral tissue expander/implant reconstruction patients: A prospective outcomes analysis. Plast Reconstr Surg. 2005;116:1642–1647
references: Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: Recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930–942
references: Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: A critical review of the literature. Plast Reconstr Surg. 2009;124:395–408
references: Percec I, Bucky LP. Successful prosthetic breast reconstruction after radiation therapy. Ann Plast Surg. 2008;60:527–531
references: Hirsch EM, Seth AK, Dumanian GA, et al. Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation. Plast Reconstr Surg. 2012;129:354–361
references: Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, Hu QY, Cordeiro PG. Postmastectomy reconstruction: An approach to patient selection. Plast Reconstr Surg. 2009;124:43–52
references: Francis SH, Ruberg RL, Stevenson KB, et al. Independent risk factors for infection in tissue expander breast reconstruction. Plast Reconstr Surg. 2009;124:1790–1796
references: Breuing KH, Colwell AS. Inferolateral AlloDerm hammock for implant coverage in breast reconstruction. Ann Plast Surg. 2007;59:250–255
references: Topol BM, Dalton EF, Ponn T, Campbell CJ. Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift. Ann Plast Surg. 2008;61:494–499
references: Namnoum JD. Expander/implant reconstruction with AlloDerm: Recent experience. Plast Reconstr Surg. 2009;124:387–394
references: Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg. 2009;124:1743–1753
references: Breuing KH, Colwell AS. Immediate breast tissue expander-implant reconstruction with inferolateral AlloDerm hammock and postoperative radiation: A preliminary report. Eplasty. 2009;9:e16
references: Nguyen MD, Chen C, Colakoğlu S, Morris DJ, Tobias AM, Lee BT. Infectious complications leading to explantation in implant-based breast reconstruction with AlloDerm. Eplasty. 2010;10:e48
references: Maxwell GP, Van Natta BW, Murphy DK, Slicton A, Bengtson BP. Natrelle Style 410 form-stable silicone breast implants: Core study results at 6 years. Aesthet Surg J. 2012;32:709–717
references: Dubin MG, Feldman M, Ibrahim HZ, et al. Allograft dermal implant (AlloDerm) in a previously irradiated field. Laryngoscope. 2000;110:934–937