title: Assessing long-term complications in patients undergoing immediate postmastectomy breast reconstruction and adjuvant radiation.
abstract: OBJECTIVE
  The purpose of this article is to report the long-term rate and timing of complications associated with postmastectomy radiation therapy (PMRT) following immediate breast reconstruction in a large patient population.
  
  
  METHODS
  We identified and reviewed the charts of all patients with stages I through IIIC breast cancer who underwent mastectomy with immediate reconstruction followed by subsequent radiation therapy between November 1997 and May 2010. We aimed to assess the rate of major complications, defined as events requiring a separate and distinct procedure. Statistical analysis between variables was evaluated using Fisher exact test and Pearson χ2Elder et al. (2005) test.
  
  
  RESULTS
  In total, 134 patients met inclusion criteria for having adequate long-term follow-up and documentation. The median follow-up for all patients was 77.4 months (range, 6-185 months). The overall major complication rate was found to be 44%. Nine patients (6.7%) experienced complications for which a secondary procedure could not be performed to retain a reconstructed breast. The average time between initiation of PMRT and the first major complication was 13.5 months, with 68.3% of first major complications occurring within 1 year of PMRT initiation and 81.7% within 2 years. The difference in incidence of major complications for patients undergoing immediate tissue expander/implant reconstruction followed by PMRT was not statistically different when compared with that for patients with immediate autologous tissue reconstruction followed by PMRT (47.3% vs 30.4%, P = .168).
  
  
  CONCLUSIONS
  The risk of first major complications and reconstruction loss in patients undergoing PMRT on immediately reconstructed breasts is greatest within 1 year of beginning radiation therapy and decreases significantly with time. Immediate autologous tissue reconstruction followed by PMRT can be performed with reasonable complication rates.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: ryan.sacotte@northwestern.edu.
authors.forename: Ryan
authors.initials: R
authors.lastname: Sacotte
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Niel
authors.initials: N
authors.lastname: Fine
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alghoul
authors.affiliation: Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Kevin
authors.initials: K
authors.lastname: Bethke
authors.affiliation: Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Nora
authors.initials: N
authors.lastname: Hansen
authors.affiliation: Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Swati
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Strauss
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: John P
authors.initials: JP
authors.lastname: Hayes
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Donnelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies; D015625:Tissue Expansion Devices; D016896:Treatment Outcome