Immediate Reconstruction of the Radiated Breast: Recent Trends Contrary to Traditional Standards

Abstract

BACKGROUND Immediate, implant-only breast reconstruction is traditionally discouraged in patients who receive radiation. It is not clear however, whether this widely-recognized mantra of breast reconstruction is observed in practice. The aim of this study is to evaluate reconstruction trends and practices in patients who have undergone mastectomy and radiation therapy. METHODS Female patients with unilateral breast cancer who required radiation in addition to mastectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Patients who underwent immediate reconstruction were identified and analyzed. Univariable and multiple logistic regression analyses were performed to study the odds of implant or combined implant-tissue reconstruction over tissue only reconstruction based on demographic and oncologic characteristics. RESULTS A total of 5,481 female patients who underwent radiation and breast reconstruction were included for analysis. The reconstruction rate among patients requiring radiation increased from 13.6% to 25.1%. The percentage of reconstructed patients who had implant only reconstruction increased from 27% to 52% (p<0.001) with a decrease in tissue only reconstruction from 56% to 32% (, p<0.001); combined implant-tissue reconstructions remained stable at an average of 13%. In regression analysis, the odds of implant reconstruction over autologous reconstruction increased each year by an odds ratio of 1.13 (95% CI 1.10–1.15). CONCLUSIONS The frequency of immediate reconstruction continues to increase in the setting of radiation therapy with a larger proportion of patients undergoing immediate implant-based reconstruction, contrary to traditional recommendations. These findings likely reflect changing attitudes towards implant reconstruction in the setting of radiation. LEVEL OF EVIDENCE I

Current Trends in Postmastectomy Breast Reconstruction

“…A population-based SEER database study of 5481 radiated patients reported that the proportion of IBRs almost doubled (14% to 25%) over the decade of 2000 [59]. Interestingly, the annual increase in the rates of reconstruction among radiated patients was steeper than that in non-radiated ones for both implants (15% versus 11%), as well as flap-based reconstructions (8% versus 6%).…”

Reconstruction of the Irradiated Breast: A National Claims-Based Assessment of Postoperative Morbidity

“…Using the SEER database, Agarwal and colleagues evaluated immediate reconstruction trends among radiated patients and found a steady increase in implant only reconstruction from 27% to 52%, with a concomitant decrease in autologous reconstruction from 56% to 32%over the past decade (9). There are concerns about the outcomes of implant reconstructions in patients who have a history of radiation or require post-mastectomy radiation therapy.…”

Cost-Effectiveness Analysis of Breast Reconstruction Options in the Setting of Postmastectomy Radiotherapy Using the BREAST-Q

“…4-6 Despite these drawbacks, increasing numbers of immediate implant reconstructions are performed in unfavorable scenarios, albeit with a greater risk profile, because of the absent donor site morbidity. 7-9 There is also the potential benefit of early breast mound restoration especially for a patient threatened by a curtailed lifespan. Finally, once radiation has been completed, expansion cannot reliably be performed thereby eliminating prosthetic methods as an option for many patients.…”