Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy

Krueger, Editha A.; Wilkins, Edwin G.; Strawderman, Myla; Cederna, Paul S.; Goldfarb, Sherry; Vicini, Frank A.; Pierce, Lori J.

doi:10.1016/s0360-3016(00)01402-4

Cited by 347 publications

(189 citation statements)

References 34 publications

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“…Some have described the influence on complication rates of treatment factors such as the use of systemic therapy and type of bolus, as well as patient and tumor-related factors such as smoking, positive lymph node status, and T3/T4 primary tumor size. 10,[12][13][14]18 Another study found no association between these factors and surgical outcomes. 16 We were unable to identify any patient or treatment-related predictors of PIRR.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Existing studies of radiation and immediate reconstruction are confounded by small groups of patients with irradiated implants treated with heterogeneous radiotherapy and surgical sequencing and techniques. [9][10][11][12][13][14][15] In addition, the median follow-ups of these studies were relatively short, and end points were variably defined. These differences led to a wide spectrum of reported complication rates ranging from 5% to 48%, underscoring the need for reliable data with lengthy follow-up in homogeneously treated patients who received immediate implantbased reconstruction and radiation.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Cordeiro

Disa

et al. 2011

Cancer

113

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BACKGROUND: Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated. METHODS: Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR. RESULTS: Median follow-up was 86 months (range, 11-161 months). The 7-year PIRRfree rate was 71% (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1% (21), and removal was 13.3% (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81% and overall survival 93%. CONCLUSIONS: Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population. Cancer 2012;118:2552-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Cordeiro

Disa

et al. 2011

Cancer

113

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“…Our finding, which suggests that both preoperative and postoperative radiotherapy are important predictors of patient satisfaction, is consistent with other published reports. Numerous studies have shown that patients who undergo postmastectomy, implant-based reconstruction after the receipt of preoperative chest wall irradiation have a higher incidence of complications, including capsular contracture, 19,[24][25][26] and that the receipt of postmastectomy adjuvant radiotherapy is correlated with both the development of complications and increased patient dissatisfaction. [27][28][29][30] Thus, the determination of effect size herein allowed clinically meaningful comparisons to be made between the effects of a known entity (such as postmastectomy radiotherapy) versus other clinical variables (such as implant type) that may have an impact on patients' satisfaction with their reconstructed breasts.…”

Section: Discussionmentioning

confidence: 99%

Patient satisfaction with postmastectomy breast reconstruction

McCarthy¹,

Klassen²,

Cano³

et al. 2010

Cancer

114

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BACKGROUND. At a time when the safety and effectiveness of breast implants remains under close scrutiny, it is important to provide reliable and valid evidence regarding patient outcomes. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life may be the most significant outcome variables when evaluating surgical success. The objective of the current study was to identify predictors of patient satisfaction with breast appearance, including implant type, in a large sample of women who underwent breast reconstruction surgery using implants. METHODS. A multicenter, cross-sectional study design was used. A total of 672 women who had completed postmastectomy, implant-based reconstruction at 1 of 3 centers in North America were asked to complete the BREAST-Q (Reconstruction Module). Multivariate linear regression modeling was performed. RESULTS. Completed questionnaire data were available for 482 of the 672 patients. In 176 women, silicone implants were placed and in 306, saline implants were used. The multivariate model confirmed that patients' satisfaction with their breasts was significantly higher in patients with silicone implants (P ¼ .016). The receipt of postmastectomy radiotherapy was found to have a significant, negative effect on breast satisfaction (P<.000) in both silicone and saline implant recipients. In addition, for women who received either silicone or saline implants, satisfaction diminished over time (P ¼ .017). CONCLUSIONS. In the setting of postmastectomy reconstruction, patients who received silicone breast implants reported significantly higher satisfaction with the results of reconstruction than those who received saline implants. This information can be used to optimize shared medical decision-making by providing patients with realistic postoperative expectations. Cancer 2010;116:5584-91.

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“…Many patients will receive postmastectomy radiotherapy (PMRT) with the temporary tissue expander present, while the tissue expander could negatively impact the effectiveness of PMRT and increase the risk of complications 9, 10. Some physicians felt the reconstructions challenged their ability to deliver effective radiotherapy 6.…”

Section: Introductionmentioning

confidence: 99%

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Yoon

Xie

Heins

et al. 2018

J Applied Clin Med Phys

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The purpose of this study was to model the metallic port in breast tissue expanders and to improve the accuracy of dose calculations in a commercial photon treatment planning system (TPS). The density of the model was determined by comparing TPS calculations and ion chamber (IC) measurements. The model was further validated and compared with two widely used clinical models by using a simplified anthropomorphic phantom and thermoluminescent dosimeters (TLD) measurements. Dose perturbations and target coverage for a single postmastectomy radiotherapy (PMRT) patient were also evaluated. The dimensions of the metallic port model were determined to be 1.75 cm in diameter and 5 mm in thickness. The density of the port was adjusted to be 7.5 g/cm3 which minimized the differences between IC measurements and TPS calculations. Using the simplified anthropomorphic phantom, we found the TPS calculated point doses based on the new model were in agreement with TLD measurements within 5.0% and were more accurate than doses calculated based on the clinical models. Based on the photon treatment plans for a real patient, we found that the metallic port has a negligible dosimetric impact on chest wall, while the port introduced significant dose shadow in skin area. The current clinical port models either overestimate or underestimate the attenuation from the metallic port, and the dose perturbation depends on the plan and the model in a complex way. TPS calculations based on our model of the metallic port showed good agreement with measurements for all cases. This new model could improve the accuracy of dose calculations for PMRT patients who have temporary tissue expanders implanted during radiotherapy and could potentially reduce the risk of complications after the treatment.

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Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy

Cited by 347 publications

References 34 publications

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Patient satisfaction with postmastectomy breast reconstruction

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

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