Postmastectomy Radiation Therapy and Two-Stage Implant-Based Breast Reconstruction: Is There a Better Time to Irradiate?

Abstract

Background The ideal timing of post-mastectomy radiation therapy (PMRT) in the setting of two-staged implant-based breast reconstruction remains unclear. In this cohort study, we sought to determine whether complication rates differed between patients who received PMRT following tissue expander placement (TE-XRT) and those who received PMRT after exchange for permanent implant (Implant-XRT) utilizing prospective, multicenter data. Methods Eligible patients in the Mastectomy Reconstruction Outcomes Consortium (MROC) study from 11 institutions across North America were included in the analysis. All patients had at least six-month follow-up after their last intervention (i.e. implant exchange for TE-XRT patients and radiation for Implant-XRT patients). Complications including seroma, hematoma, infection, wound dehiscence, capsular contracture, and implant loss were recorded. Results We identified a total of 150 patients who underwent immediate, two-staged implant-based breast reconstruction and received PMRT. Of these, there were 104 (69.3%) TE-XRT and 46 (30.7%) Implant-XRT patients. There were no differences in the incidence of any complications or complications leading to reconstructive failure between the two cohorts. After adjusting for patient characteristics and site effect, the timing of PMRT (i.e. TE-XRT versus Implant-XRT) was not a significant predictor in the development of any complication, a major complication, or reconstructive failure. Conclusions In the setting of PMRT and two-staged implant-based reconstruction, patients who received PMRT after expander placement (TE-XRT) did not have a higher incidence or increased odds of developing complications than those who received PMRT after exchange for a permanent implant (Implant-XRT).

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

“…There was overwhelming panel preference for a delayed‐immediate implant‐based approach when PMRT was likely, although a consensus could not be reached on whether it was preferable to irradiate an expander‐implant versus a permanent implant. Recent data from the MROC longitudinal cohort study showed no differences in either clinical or cosmetic outcomes for irradiation of an expander compared with a permanent implant.…”

“…The generic reference to ‘breast reconstruction’ was intended to capture all articles addressing the type and timing of breast reconstruction. Two authors independently reviewed abstracts of all studies published between 1985 and 2014, and the full texts of those studies published in 2015–2017. Levels of clinical evidence (LoE) were evaluated for each publication and scored from I to V by employing Oxford criteria.…”

Long‐term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant‐based reconstruction

“…We also identified a significantly higher rate of reconstruction failure at 5 years with TE/I, compared to AR, for patients with overweight BMI (25.1‐30) and obese BMI (>30), but not for patients with normal BMI (≤25). It is well established in the literature that patients with current or previous smoking history and BMI ≥ 30 have a significant higher risk of failure of reconstruction . Additionally, these factors also increase the risk of infection and data have demonstrated that the most common etiology of implant‐based reconstruction failure is infection .…”

“…It is well established in the literature that patients with current or previous smoking history and BMI ≥ 30 have a significant higher risk of failure of reconstruction. [16][17][18][19] Additionally, these factors also increase the risk of infection and data have demonstrated that the most common etiology of implant-based reconstruction failure is infection. 20 We have identified that infections account for a substantial proportion of reconstruction failures in our series.…”

Breast Implants and Radiation

“…The Mastectomy Reconstruction Outcomes Consortium (MROC) study represents the largest and most thorough review of postmastectomy radiation therapy and two-stage implant-based reconstruction. 36 In this study, 150 patients were identified from 11 institutions across North America (►Table 1). There were 104 patients who received radiation to their tissue expander (69.3%) compared with 46 who received radiation to their implant (30.7%).…”