Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?

Abstract

Background Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%). Results In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications. Conclusions IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR. Trial registration Patients were selected and registered retrospectively, and medical records were evaluated.

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

“…There has been a paradigm shift in the management of breast cancer and the advent of oncoplastic breast surgery has revolutionised the concept of breast preservation, utilising limited tissue resection as opposed to a mastectomy [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]. Although breast conservation therapy can be an attractive alternative, it is dependent upon a number of clinical factors including tumour size and location, and importantly approximately 40% of women with primary breast cancer still undergo mastectomy [ 14 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ].…”

“…At most breast centres, the majority of reconstructions is performed immediately, in a joint procedure between the breast surgeon, who performs the mastectomy, and the plastic surgeon [ 15 ], [ 19 ], [ 31 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ]. Pre-operatively, this allows for mastectomy skin sparing incisions to be discussed between the two teams which can then be incorporated in the final decision on the optimal reconstruction to best suit the patient.…”

“…They can be silicone or saline filled, but the former is believed to be superior in creating a soft and aesthetically pleasing breast shape. Another alternative is the use of tissue expanders, which are placed under the pectoralis major muscle and inflated at weekly intervals to allow for expansion of the overlying tissues [ 31 ], [ 36 ]. This can then be replaced with a permanent implant once the desired volume is achieved [ 31 ], [ 36 ].…”

“…Another alternative is the use of tissue expanders, which are placed under the pectoralis major muscle and inflated at weekly intervals to allow for expansion of the overlying tissues [ 31 ], [ 36 ]. This can then be replaced with a permanent implant once the desired volume is achieved [ 31 ], [ 36 ]. Although the use of breast implants can be advantageous in breast reconstruction as it provides an aesthetically pleasing result with a short recovery period, it is not recommended for patients undergoing post-mastectomy radiotherapy due to the potential risk of wound breakdown and extrusion [ 31 ], [ 32 ], [ 33 ], [ 47 ].…”

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

“…Several randomized controlled trials have demonstrated that sequencing differently chemotherapy and radiotherapy may not affect the oncologic outcomes, given that the adjuvant radiotherapy starts within 7 months after mastectomy. PMRT can target the tissue expander in situ or after the exchange of the implant, usually occurring 3 months after the initial placement [66, 67].…”