title: Impact of total skin-sparing mastectomy incision type on reconstructive complications following radiation therapy.
abstract: BACKGROUND
  Postoperative complications after total skin-sparing mastectomy and expander-implant reconstruction can negatively impact outcomes, particularly in the setting of postmastectomy radiation therapy. The authors studied whether rates of ischemic complications after postmastectomy radiation therapy are impacted by the total skin-sparing mastectomy incision.
  
  
  METHODS
  The authors queried a prospectively collected database of patients undergoing total skin-sparing mastectomy and immediate two-stage expander-implant reconstruction. Their hypothesis was that, in the setting of radiation therapy, patients with inframammary incisions would be more likely to develop ischemic complications than those without incisions on the dependent portion of the breast. We divided our patient cohort into two groups, those with inframammary incisions and those with other incisions, and then analyzed the proportion that received radiation therapy.
  
  
  RESULTS
  Of 756 cases included in the analysis, 91 (12 percent) received postmastectomy radiation therapy, 62 (68.1 percent) with inframammary incisions and 29 (31.9 percent) with other incisions. Mean follow-up was 3.1 years. Rates of mastectomy skin flap necrosis (3.2 percent versus 6.9 percent, p=0.4) following radiation therapy were not significantly higher in the inframammary group. However, breakdown of the total skin-sparing mastectomy incision was twice as likely in the inframammary group (21 percent versus 10.3 percent, p=0.2) and was more likely to lead to subsequent implant removal when incisional breakdown occurred (77 percent versus 0 percent, p=0.03).
  
  
  CONCLUSIONS
  Total skin-sparing mastectomy incision type may impact rates of incisional breakdown and implant loss following postmastectomy radiation therapy, with higher rates seen with inframammary incisions. Multiple factors, including breast size, breast ptosis, and likelihood of radiation therapy, should be considered in determining optimal incision.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: San Francisco, Calif.; and Durham, N.C. From the Divisions of Plastic and Reconstructive Surgery and Breast Surgery, Department of Surgery, and the Department of Radiation Oncology, University of California, San Francisco; and the School of Medicine, Duke University.
authors.forename: Anne Warren
authors.initials: AW
authors.lastname: Peled
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foster
authors.forename: Cassandra
authors.initials: C
authors.lastname: Ligh
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.forename: Barbara
authors.initials: B
authors.lastname: Fowble
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
mesh_terms: D000328:Adult; D001940:Breast / Q000098:blood supply* / Q000528:radiation effects; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D013524:Surgical Flaps / Q000098:blood supply*; D015626:Tissue Expansion; D016896:Treatment Outcome
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