title: Immediate implant-based breast reconstruction following total skin-sparing mastectomy: defining the risk of preoperative and postoperative radiation therapy for surgical outcomes.
abstract: BACKGROUND
  Radiation therapy is increasingly used in breast cancer therapy. With total skin-sparing mastectomy and nipple/areola complex preservation, defining the risks of various treatment regimens for morbidity is important, in the setting of immediate prosthetic reconstruction. The authors assessed the effects of premastectomy and postmastectomy radiation therapy on outcomes in total skin-sparing mastectomy and immediate prosthetic reconstruction.
  
  
  METHODS
  All patients undergoing total skin-sparing mastectomy and immediate prosthetic reconstruction at the authors' institution between 2006 and 2012 were identified. Cohort 1 included patients undergoing total skin-sparing mastectomy and reconstruction with no radiation. Cohort 2 included patients with a prior history of radiation before total skin-sparing mastectomy and reconstruction. Cohort 3 included patients undergoing radiation after total skin-sparing mastectomy and reconstruction.
  
  
  RESULTS
  A total of 580 patients underwent 903 breast reconstructions following total skin-sparing mastectomy. Cohort 1 included 727 breasts, cohort 2 included 63 breasts, and cohort 3 included 113 breasts. Any radiation delivery caused an increased rate of infection requiring antibiotics (21.6 percent, p = 0.00) and an increased risk of expander/implant loss (18.75 percent, p = 0.00). Cohort 2 had a higher risk of wound breakdown (p = 0.012). All cohorts showed similar low rates of nipple/areola necrosis.
  
  
  CONCLUSIONS
  Both preoperative and postoperative radiation following total skin-sparing mastectomy and immediate prosthetic reconstruction result in higher, but acceptable, complication risks. Complications related to nipple/areola preservation are similar to those in nonradiated patients and in those undergoing skin-sparing mastectomy. Thus, nipple/areola complex preservation is safe in women undergoing radiation therapy.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: San Francisco, Calif. From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, and the Department of Radiation Oncology, University of California, San Francisco.
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
authors.forename: Frederick
authors.initials: F
authors.lastname: Wang
authors.forename: Anne W
authors.initials: AW
authors.lastname: Peled
authors.forename: Rachel
authors.initials: R
authors.lastname: Lentz
authors.forename: Michael
authors.initials: M
authors.lastname: Alvarado
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Ewing
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.forename: Barbara
authors.initials: B
authors.lastname: Fowble
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foster
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000295:instrumentation / Q000379:methods; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D015626:Tissue Expansion; D016896:Treatment Outcome