Radiation Therapy after Immediate Breast Reconstruction with Implants

Vandeweyer, Eric; Deraemaecker, Rika

doi:10.1097/00006534-200007000-00010

Cited by 29 publications

(39 citation statements)

References 9 publications

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“…Over the last two decades, many studies have been published about the negative effects of radiation on tissue expander breast reconstructions. Earlier studies were limited by small patient populations, older radiation techniques, and often failed to take into account risk factors for complications other than radiation therapy (7)(8)(9)(10)(11)(12)(13). More recent studies dealt with larger numbers of radiated patients and looked into risk factors for complications, but few took into account the interactions between multiple risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Complications of Radiation Therapy on Tissue Expander Breast Reconstructions

Brooks¹,

Djohan²,

Tendulkar³

et al. 2011

The Breast Journal

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Radiation therapy has been shown to increase complication rates of tissue expander/implant breast reconstructions. The purpose of this study was to evaluate patient characteristics to assess their impact on complications. A retrospective review of patients who underwent mastectomy plus tissue expander/implant reconstruction from January 2000 to December 2006 was performed. The main outcome of interest was the development of postoperative complications. Analyses were performed to detect risk factors for complications. A total of 560 patients were included in the study. A total of 385 patients underwent unilateral and 174 underwent bilateral tissue expander/implant reconstructions, for a total of 733 reconstructions. A total complication rate of 31.8% and a major complication rate of 24.4% were calculated. The risk factors associated with a significantly increased incidence of complications were age greater than 50 years, body mass index (BMI) greater than 30, and radiation. Women younger than 50 years had a complication rate of 28.4%, whereas women older than 50 years had a complication rate of 37.0%. Women with a BMI less than 30 had a complication rate of 27.5%, whereas women with a BMI greater than 30 had a complication rate of 49%. The major complication rate in nonradiated and radiated patients was 21.2% and 45.4%, respectively. Despite higher complication rates, tissue expander/implant reconstructions were successful in 70.1% of radiated patients. Based on this study, the ideal radiated patient would have a BMI less than 30 and be younger than 50 years of age to maximize the likelihood of a successful tissue expander/implant reconstruction.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Complications of Radiation Therapy on Tissue Expander Breast Reconstructions

Brooks¹,

Djohan²,

Tendulkar³

et al. 2011

The Breast Journal

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show abstract

“…4 Finally, in women with a history of breast radiotherapy or who are likely to require postoperative radiotherapy, implant-based reconstruction is associated with increased prevalence of wound dehiscence, capsular contracture, and implant extrusion. [5][6][7][8][9] In these situations, autologous reconstruction is preferred as it brings vascular-ized, non-irradiated tissue into a radiated tissue bed. In a thin woman who meets any of these criteria, autologous reconstruction may be the preferred reconstructive choice.…”

mentioning

confidence: 99%

Are patients with low body mass index candidates for deep inferior epigastric perforator flaps for unilateral breast reconstruction?

et al. 2015

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Thin women have not traditionally been considered ideal candidates for autologous breast reconstruction. The purpose of this study was to examine the use of deep inferior epigastric perforator (DIEP) flap reconstruction in thin women undergoing immediate unilateral breast reconstruction. A retrospective review of 1,040 consecutive patients was performed. In total, 381 patients met the inclusion criteria. To improve clinical interpretability, patients were divided into three groups based on body mass index: "thin" (BMI ≤ 22.99), "traditional" (>23 and ≤29.99), and "obese" (BMI >30) candidates. Flap characteristics were compared to mastectomy weights, and postoperative complications were analyzed. In all groups, flap size was generally more than sufficient to match the mastectomy specimen, as flap weight:mastectomy weight ratio ws greater than 1 in all groups with no significant difference between groups (1.1 in thin patients, 1.0 in traditional patients, and 1.0 in obese patients). Fat necrosis prevalence was lowest in the thin group (12.5%), compared to the traditional (15.9%, P = 0.443) or obese (14.4%, P = 0.698) groups. Prevalence of breast infection were lower in the thin patients (5.2%) versus the traditional (8.7%, P = 0.287) or obese (14.4%, P = 0.033). Abdominal wound healing complications and seroma were also lowest in thin patients. DIEP flap breast reconstruction may be an effective method for unilateral breast reconstruction in thin patients, with sufficient flap weights and lower incidence of complications than in heavier patients. As such, low BMI may not present a barrier in the reconstruction of a breast mound matching native breast size.

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“…The first operation employs a temporary tissue expander to provide controlled stretch of chest tissues, followed by a second operation to exchange the expander for a permanent implant. Implants have a faster recovery and are easier to place but have higher complication rates and are not recommended in patients receiving adjuvant radiation . Thus for some patients, AR is the best option.…”

mentioning

confidence: 99%

Breast Reconstruction National Trends and Healthcare Implications

et al. 2013

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Breast reconstruction improves quality-of-life of breast cancer patients. Different reconstructive options exist, yet commentary in the plastic surgery literature suggests that financial constraints are limiting access to autologous reconstruction (AR). This study follows national trends in breast reconstruction and identifies factors associated with reconstructive choices. Data were obtained from the Nationwide Inpatient Sample from 1998 to 2008. Patients were categorized as having either implant or ARs. Bivariate and multivariate regression analysis identified variables associated with receiving implants versus AR. Physician fee schedules were analyzed using national average Medicare physician reimbursement rates. From 1998 to 2008, 324,134 breast reconstructions were performed. Reconstructions increased 4% per year. The proportion of implant reconstructions increased 11% per year, whereasARs decreased 5% per year (p < 0.05). Our model showed that the odds of having implant-based versus AR were significantly associated with age, disease severity, payer type, hospital teaching status, and year of surgery. Year of surgery was the strongest predictor of implant reconstruction; patients receiving breast reconstructive surgery in 2009 were three times more likely to have implant breast reconstructive surgery compared with similar patients in 2002. Medicare reimbursement steadily declined for AR over a similar time frame. From 1998 to 2008, autologous breast reconstruction has significantly declined, parallel to a decrease in physician reimbursement. Our data found no significant change in patient characteristics supporting the lack of choice of AR. Further research is warranted to better understand this shift to implant reconstruction and to ensure future access of these complex reconstructive procedures.

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Radiation Therapy after Immediate Breast Reconstruction with Implants

Cited by 29 publications

References 9 publications

Risk Factors for Complications of Radiation Therapy on Tissue Expander Breast Reconstructions

Risk Factors for Complications of Radiation Therapy on Tissue Expander Breast Reconstructions

Are patients with low body mass index candidates for deep inferior epigastric perforator flaps for unilateral breast reconstruction?

Breast Reconstruction National Trends and Healthcare Implications

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