title: The Impact of Expander Inflation/Deflation Status During Adjuvant Radiotherapy on the Complications of Immediate Two-Stage Breast Reconstruction.
abstract: BACKGROUND
  The question of whether expander inflation/deflation status has any bearing on surgical complications in the setting of adjuvant radiation (XRT) has not been addressed. The objective of this study is to investigate whether the inflation/deflation status of the expander at the time of XRT is associated with complications in immediate two-stage expander-implant breast reconstruction.
  
  
  METHODS
  A retrospective review of 49 consecutive patients who underwent immediate two-stage expander-implant breast reconstruction and received post-mastectomy XRT was conducted. Full deflation of the expanders was performed in the deflation group (20 patients), while the expanders remained inflated in the inflation group at the time of XRT (29 patients). XRT-related complications of each stage of reconstructions were compared between the two groups, and multivariable regression analysis was performed to identify risk factors for XRT-related complications.
  
  
  RESULTS
  Overall XRT-related complications (65.0 vs. 6.9%, p < 0.001) and reconstruction failures (35.0 vs. 6.9%, p = 0.022) of the first-stage reconstructions were significantly higher in the deflation group. The most common cause of reconstruction failure in the deflation group was failure to re-expand due to skin fibrosis and contracture. In multivariable analysis, deflation of expanders was a significant risk factor for overall complications (odds = 94.4, p = 0.001) and reconstruction failures (odds = 9.09, p = 0.022) of the first-stage reconstructions.
  
  
  CONCLUSIONS
  Maximal inflation without deflation before XRT can be an option to minimize XRT-related complications and reconstruction failure of the first-stage reconstructions.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea.
authors.forename: Kyong-Je
authors.initials: KJ
authors.lastname: Woo
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-ro 81, Seoul, 135-710, South Korea.
authors.forename: Joo-Myeong
authors.initials: JM
authors.lastname: Paik
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-ro 81, Seoul, 135-710, South Korea.
authors.forename: Sa Ik
authors.initials: SI
authors.lastname: Bang
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-ro 81, Seoul, 135-710, South Korea. supramicro@gmail.com.
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-ro 81, Seoul, 135-710, South Korea. pspriest.pyon@samsung.com.
authors.forename: Jai-Kyong
authors.initials: JK
authors.lastname: Pyon
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011475:Prosthesis Failure; D018714:Radiotherapy, Adjuvant; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Adjuvant radiation; Breast reconstruction; Deflation; Expanders; Inflation