Radiation Therapy and Expander-Implant Breast Reconstruction

Lentz, Rachel; Ng, Reuben; Higgins, Susan A.; Fusi, Stefano; Matthew, Michael K.; Kwei, Stephanie

doi:10.1097/sap.0b013e3182834b63

Cited by 59 publications

(23 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…42–44 In a recent study, radiation therapy increased the rate of permanent implant infection and removal by approximately 5-fold compared to non-radiated breasts, similar to the odds ratio of 4 that our study observed. 45 In a separate study with a longer follow-up period, 9% of post-mastectomy irradiation patients suffered implant loss, as compared to 0.5% in the control population. 46 Radiation therapy also reduces the likelihood of implant salvage following infection or prosthesis exposure.…”

Section: Discussionmentioning

confidence: 91%

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Sinha

Pusic

Wilkins

et al. 2017

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Introduction Surgical site infection (SSI) can cause devastating reconstructive failure in implant-based breast reconstructions. Many large national database studies have offered insights into complication rates, but only capture early outcomes within 30-days post-operatively. This study evaluates both early and late SSI in immediate implant-based reconstruction and identifies predictors. Methods As part of the Mastectomy Reconstruction Outcomes Consortium Study (MROC), 1662 implant-based breast reconstructions in 1024 patients were evaluated for early vs. late SSI. Early SSI was defined as infection occurring within 30 days post-operatively and late SSI as infection occurring 31 days to 1 year. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant (DTI) patients had one-year follow-up, and tissue-expander (TE) patients had one-year post-exchange follow-up. Results Among 1491 TE and 171 DTI reconstructions, overall SSI rate for TE was 5.7% (85/1491) after first-stage, 2.5% (31/1266) after second-stage, and 9.9% (17/171) for DTI. Over 47–71% of SSI complications occurred as late SSI. Multivariate analysis identified radiotherapy and BMI as significant predictors of late SSI. No significant difference between DTI and TE group in the occurrence of early, late, or overall SSI was found. Conclusions The majority of SSI complications in immediate implant-based breast reconstructions are late infections occurring more than 30 days following both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset SSI. Current studies limited to early complications do not present an accurate or complete assessment of infection complications associated with implant-based breast reconstructions or their long-term clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 91%

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Sinha

Pusic

Wilkins

et al. 2017

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…However, the timing of the exchange after PMRT may affect the presence or type of complication that occurs. 38 Some reports reveal that delayed/2-stage, implant-based reconstruction in patients receiving radiation therapy and adjuvant chemotherapy result in fewer complications than immediate replacement of the expander. 39 In a study on the timing of implant exchange with TE and PMRT, it was found that performing implant exchange earlier after PMRT (<4 months) resulted in a higher rate of infections, whereas later exchange (>4 months) resulted in a higher rate of capsular contracture, although not statistically significant.…”

Section: Resultsmentioning

confidence: 99%

“… 39 In a study on the timing of implant exchange with TE and PMRT, it was found that performing implant exchange earlier after PMRT (<4 months) resulted in a higher rate of infections, whereas later exchange (>4 months) resulted in a higher rate of capsular contracture, although not statistically significant. 38 …”

Section: Resultsmentioning

confidence: 99%

Breast Reconstruction and Radiation Therapy

2018

View full text Add to dashboard Cite

Purpose:The optimal approach to the integration of postmastectomy reconstruction and radiation therapy is not well-established. This review will summarize current literature pertaining to the most common types of reconstruction in the setting of postmastectomy radiation therapy (PMRT).Data Sources:Literature from PubMed was reviewed from 2000 to 2016.Study Selection:Studies were selected with relevance to “postmastectomy breast reconstruction,” “breast reconstruction,” and “breast reconstructive methods and PMRT.” Surgical outcomes, patient satisfaction, and cost-effectiveness were examined.Data Extraction:Data from publications was extracted, summarized, and converted to a table.Results of Data Synthesis:Implant-based techniques are on the rise, in the setting of PMRT. Implant-based methods are more affordable in the short term and result in immediate breast-mound formation compared to autologous methods. When compared to implant-based reconstruction with PMRT, autologous reconstruction with PMRT results in better quality of life (QoL) and sensory recovery as well as fewer complications and failures. Among autologous flaps, deep inferior epigastric perforator flaps are considered superior to transverse rectus abdominal muscle (TRAM) pedicled flaps and may be more suitable for PMRT. Latissimus dorsi and muscle-sparing free TRAM flaps are also viable options. In delayed autologous, which may be advantageous for high-risk patients, the optimal timing to delay surgery after radiation therapy is unknown. Reconstruction with a 2-stage tissue expander-implant technique offers good to excellent cosmetic outcomes in the setting of PMRT, although there may be complications in this 2-stage process.Conclusion:Surgical, cosmetic, quality of life, and life expectancy must be taken into account when selecting the way to integrate breast reconstruction and PMRT.

show abstract

“…Donor site morbidity is a major issue in flap procedures [28]. Capsule formation after prosthetic implants and radiotherapy-induced complications are still challenging [29, 30]. In general, autologous methods are favorable in terms of long-term stability of results.…”

Section: Discussionmentioning

confidence: 99%

The effect of lipoaspirates vs. dissected abdominal fat on breast cancer cells in vitro

et al. 2017

View full text Add to dashboard Cite

BackgroundCancer cells are typically surrounded by stromal cells and embedded in extracellular matrix (ECM). The stromal compartment interacts with cancer cells to promote growth and metastasis. For decades, autologous fasciocutaneous flaps have been safely applied for breast reconstruction after mastectomy. In contrast, the safety of fat grafting (lipofilling) procedure has been under debate regarding the risk of cancer recurrence.MethodsHarvested fat tissue (lipoaspirates) and dissected abdominal fat (DAF) were co-cultured with MCF-7 breast cancer cells. The vitality of MCF-7 cells was measured using AlamarBlue® consecutively for 5 days. ECM degradation was determined by detection of matrix metalloproteinase-1 (MMP-1) expression in MCF-7 cells. Integrin α2 was measured by Western blot to assess the degree of adhesion and motility of MFC-7 cells.ResultsThe MCF-7 proliferation increased substantially when co-cultured with fat tissue. However, there was no significant difference between the proliferation stimulating effects of lipoaspirates and DAF. Similarly, MMP-1 protein expression was equally elevated in MCF-7 cells by both lipoaspirates and DAF. Importantly, MCF-7 cells showed an increased level of integrin α2 once co-cultured with either lipoaspirates or DAF.ConclusionFat tissue increases the proliferation of MCF-7 cells in vitro. Our data suggest that lipoaspirates as well as DAF might possess a considerable potency to promote tumorigenic growth of breast cancer cells. Thus, clinical trials are needed to address the safety of lipofilling by breast reconstruction surgery after mastectomy.

show abstract

Radiation Therapy and Expander-Implant Breast Reconstruction

Cited by 59 publications

References 16 publications

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Breast Reconstruction and Radiation Therapy

The effect of lipoaspirates vs. dissected abdominal fat on breast cancer cells in vitro

Contact Info

Product

Resources

About