title: Postmastectomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: a University of British Columbia perspective.
abstract: BACKGROUND
  An increasing number of women who undergo immediate two-stage tissue expander/implant breast reconstruction will require postmastectomy radiation therapy. An important variable is the timing of radiotherapy relative to surgery. The authors report their experience treating a large consecutive series of patients who underwent postmastectomy radiation therapy to the tissue expander before exchange for a permanent implant.
  
  
  METHODS
  Patients who had their tissue expander irradiated before implant exchange were identified. Complications, capsular contracture, revision surgery, and autologous salvage rates of irradiated patients were compared with a control group of nonirradiated patients.
  
  
  RESULTS
  Immediate two-stage tissue expander/implant reconstruction was initiated in 604 patients, with 113 irradiated breasts meeting inclusion criteria. Three hundred thirty-nine nonirradiated breasts constituted the control group. There was a 4.2 increased odds of major complications in the irradiated group, after adjusting for plastic surgeon, age, body mass index, smoking, chemotherapy, and cancerous breast (OR, 4.2; p=0.001). The grade III and IV capsular contracture rate was significantly higher in the irradiated group compared with the control group (21.7 percent versus 10 percent; p<0.008). The revision rate in the control group was higher compared with the irradiated group (30.2 percent versus 20.9 percent; p<0.001).
  
  
  CONCLUSIONS
  Postmastectomy irradiation to the tissue expander is associated with high complications; however, these patients have an acceptable capsular contracture rate that compares favorably with other implant-based radiotherapy algorithms. Revision rates were less than expected in irradiated breasts. This study suggests that immediate tissue expander/implant reconstruction is a reasonable surgical option in the setting of postmastectomy radiation therapy.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Vancouver, British Columbia, Canada From the Division of Plastic and Reconstructive Surgery, University of British Columbia; and the Department of Radiation Oncology and Developmental Radiotherapeutics, British Columbia Cancer Agency.
authors.forename: Adelyn L
authors.initials: AL
authors.lastname: Ho
authors.forename: Esta S
authors.initials: ES
authors.lastname: Bovill
authors.forename: Sheina A
authors.initials: SA
authors.lastname: Macadam
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.forename: Janice
authors.initials: J
authors.lastname: Giang
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lennox
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D001955:British Columbia; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D015626:Tissue Expansion / Q000379:methods*; D014495:Universities; D055815:Young Adult