title: The Impact of Radiation Therapy, Lymph Node Dissection, and Hormonal Therapy on Outcomes of Tissue Expander-Implant Exchange in Prosthetic Breast Reconstruction.
abstract: BACKGROUND
  Total skin-sparing mastectomy, with preservation of the nipple-areola complex, must account for adjuvant medical and surgical treatments for cancer. The authors assessed risk factors for complications after second-stage tissue expander-implant exchange.
  
  
  METHODS
  The authors reviewed all institutional total skin-sparing mastectomy cases that had completed tissue expander-implant exchange with at least 3 months of follow-up. They developed multivariate generalized estimating equation models to obtain adjusted relative risks of radiation therapy, type of lymph node dissection, and hormonal therapy in relation to postoperative complications.
  
  
  RESULTS
  The authors performed 776 cases in 489 patients, with a median follow-up of 26 months (interquartile range, 10 to 48 months). Radiation therapy was associated with increased wound breakdown risk [relative risk (RR), 3.3; 95 percent CI, 2.0 to 5.7]; infections requiring oral antibiotics (RR, 2.2; 95 percent CI, 1.31 to 3.6), intravenous antibiotics (RR, 6.4; 95 percent CI, 3.9 to 10.7), or procedures (RR, 8.9; 95 percent CI, 4.5 to 17.5); implant exposure (RR, 3.9; 95 percent CI, 1.86 to 8.3); and implant loss (RR, 4.2; 95 percent CI, 2.4 to 7.4). Axillary lymph node dissection was associated with an increased risk of implant loss (RR, 2.0; 95 percent CI, 1.11 to 3.7) relative to sentinel lymph node biopsy.
  
  
  CONCLUSIONS
  Axillary lymph node dissection increases the risk of implant loss compared with sentinel lymph node biopsy, independent of radiation therapy. Patients who require axillary lymph node dissection may be encouraged to undergo breast conservation or autologous reconstruction when possible.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: San Francisco, Calif. From the Division of Plastic and Reconstructive Surgery, the Carol Franc Buck Breast Care Center, Department of Surgery, and the Department of Radiation Oncology, University of California, San Francisco.
authors.forename: Frederick
authors.initials: F
authors.lastname: Wang
authors.forename: Anne Warren
authors.initials: AW
authors.lastname: Peled
authors.forename: Robin
authors.initials: R
authors.lastname: Chin
authors.forename: Barbara
authors.initials: B
authors.lastname: Fowble
authors.forename: Michael
authors.initials: M
authors.lastname: Alvarado
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ewing
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.forename: Robert
authors.initials: R
authors.lastname: Foster
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects; D001365:Axilla; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D015626:Tissue Expansion / Q000009:adverse effects*; D015625:Tissue Expansion Devices / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal