Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy.
OBJECTIVE
Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT).


METHODS
Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years.


RESULTS
Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar.


CONCLUSIONS
RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and with a preferred interval of 6 months to exchange.
Department of Radiation Oncology, University of California San Francisco, San Francisco, California. Electronic address: BFowble@radonc.ucsf.edu.
Barbara
B
Fowble
Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
Catherine
C
Park
Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California.
Frederick
F
Wang
Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California.
Anne
A
Peled
Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California.
Michael
M
Alvarado
Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California.
Cheryl
C
Ewing
Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California.
Laura
L
Esserman
Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California.
Robert
R
Foster
Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California.
Hani
H
Sbitany
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Alex
A
Hanlon
D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001835:Body Weight; D018427:Breast Implants; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000532:radiotherapy* / Q000601:surgery*; D002921:Cicatrix / Q000150:complications / Q000473:pathology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D064169:Intermediate Back Muscles / Q000637:transplantation; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D059351:Organ Sparing Treatments / Q000379:methods; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D012189:Retrospective Studies; D015625:Tissue Expansion Devices; D017211:Treatment Failure