title: Factors affecting complications in radiated breast reconstruction.
abstract: BACKGROUND
  Breast irradiation in combination with breast reconstruction is associated with increased complications. Because of the diminishing threshold for radiotherapy, breast reconstruction irradiation is rising. Our aim was to evaluate factors affecting outcomes in irradiated breast reconstructions.
  
  
  METHODS
  A review of consecutive patients who underwent mastectomy, radiation, and breast reconstruction was conducted. Patient demographics, operative procedure, breast irradiation timing, and postoperative complications were collected.
  
  
  RESULTS
  One hundred fifty-four patients (157 breast reconstructions) were included with a mean follow-up of 6 years. Average age at reconstruction was 50 years. One hundred nine cases were immediate and 48 cases were delayed. Sixty-eight cases were autologous reconstructions and 89 cases were implant-based. Thirty-seven cases used acellular dermal matrices (ADMs); 60% of cases were radiated before reconstruction and 40% were radiated afterward. Major complications occurred in 43% of patients and minor complications occurred in 17%. The presence of ADM led to an increase in complication rate with a 2.3-fold greater chance of requiring reoperation (P = 0.03). No significant difference in complication rates was associated with presence of hypertension, diabetes, smoking, elevated body mass index, autologous versus implant-based reconstructions, delayed versus immediate reconstructions, and time between radiation and reconstruction.
  
  
  CONCLUSIONS
  Radiation after prosthetic reconstruction may produce an increase in failure rates. The use of ADMs in the face of breast irradiation increases the likelihood of a complication requiring reoperation.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-1075, USA.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Pestana
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Campbell
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bharti
authors.forename: James T
authors.initials: JT
authors.lastname: Thompson
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003094:Collagen / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: C440568:Alloderm; D003094:Collagen