Impact of Prior Unilateral Chest Wall Radiotherapy on Outcomes in Bilateral Breast Reconstruction.
BACKGROUND
The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction.


METHODS
A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control. Descriptive and bivariate statistics were computed. Multiple regression statistics were computed to identify adjusted associations between chest wall radiotherapy and complications.


RESULTS
Seventy patients were included in the study. The mean follow-up period was 51.8 months (range, 10 to 113 months). Thirty-eight patients underwent implant-based breast reconstruction; 32 patients underwent abdominal autologous flap reconstruction. Previously irradiated breast had a significantly higher rate of overall complications (51 percent versus 27 percent; p < 0.0001), infection (13 percent versus 6 percent; p = 0.026), and major skin necrosis (9 percent versus 3 percent; p = 0.046). After adjusting for age, body mass index, reconstruction method, and medical comorbidities, prior chest wall radiotherapy was a significant risk factor for breast-related complications (OR, 2.98; p < 0.0001), infection (OR, 2.59; p = 0.027), and major skin necrosis (OR, 3.47; p = 0.0266). There were no differences between implant-based and autologous reconstructions with regard to complications (p = 0.76).


CONCLUSIONS
Prior chest wall radiotherapy is associated with a 3-fold increased risk of postoperative complications following immediate breast reconstruction.


METHODS
Therapeutic, III.
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Thiago B
TB
de Araujo
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Mary
M
Jue Xu
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Srinivas M
SM
Susarla
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Karen
K
Shmelev
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Wei
W
Jiang
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Julian J
JJ
Pribaz
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Charles
C
Hergrueter
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Matthew J
MJ
Carty
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Stephanie
S
Caterson
Brasília, Brazil; Boston, Mass.; Baltimore, Md.; and New York, N.Y.|From the CAPES Foundation, Ministry of Education; Harvard Medical School, the Center for Surgery and Public Health, Brigham and Women's Hospital, and Brigham and Women's Hospital Plastic Surgery; Johns Hopkins University, School of Medicine; and New York Medical College.
Yoon S
YS
Chun
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D035441:Thoracic Wall
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