title: Reconstruction of the Irradiated Breast: A National Claims-Based Assessment of Postoperative Morbidity.
abstract: BACKGROUND
  Implant-based reconstruction rates have risen among irradiation-treated breast cancer patients in the United States. This study aims to assess the morbidity associated with various breast reconstruction techniques in irradiated patients.
  
  
  METHODS
  From the MarketScan Commercial Claims and Encounters database, the authors selected breast cancer patients who had undergone mastectomy, irradiation, and breast reconstruction from 2009 to 2012. Demographic and clinical treatment data, including data on the timing of irradiation relative to breast reconstruction were recorded. Complications and failures after implant and autologous reconstruction were also recorded. A multivariable logistic regression model was developed with postoperative complications as the dependent variable and patient demographic and clinical variables as independent variables.
  
  
  RESULTS
  Four thousand seven hundred eighty-one irradiated patients who met the inclusion criteria were selected. A majority of the patients [n = 3846 (80 percent)] underwent reconstruction with implants. Overall complication rates were 45.3 percent and 30.8 percent for patients with implant and autologous reconstruction, respectively. Failure of reconstruction occurred in 29.4 percent of patients with implant reconstruction compared with 4.3 percent of patients with autologous reconstruction. In multivariable logistic regression, irradiated patients with implant reconstruction had two times the odds of having any complication and 11 times the odds of failure relative to patients with autologous reconstruction.
  
  
  CONCLUSIONS
  Implant-based breast reconstruction in the irradiated patient, although popular, is associated with significant morbidity. Failures of reconstruction with implants in these patients approach 30 percent in the short term, suggesting a need for careful shared decision-making, with full disclosure of the potential morbidity.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Chetta
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Aliu
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhong
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Erika D
authors.initials: ED
authors.lastname: Sears
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.affiliation: Ann Arbor, Mich.|From the Section of Plastic Surgery, University of Michigan.
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001940:Breast / Q000528:radiation effects* / Q000601:surgery*; D019928:Breast Implantation; D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D055815:Young Adult