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

Brooks, Susan L.; Djohan, Risal; Tendulkar, Rahul D.; Nutter, Benjamin; Lyons, Joanne; Dietz, Jill R.

doi:10.1111/j.1524-4741.2011.01182.x

Cited by 44 publications

(27 citation statements)

References 21 publications

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“…Implant‐based breast reconstruction is more common than autologous reconstruction and, in general, is associated with higher complication rates . Obesity is becoming the norm in this patient population, and it commonly co‐exists with other factors influencing surgical risk.…”

Section: Introductionmentioning

confidence: 76%

Operative risk stratification in the obese female undergoing implant‐based breast reconstruction

2019

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The prevalence of obesity is growing, and breast reconstruction in the obese patient is becoming the norm rather than the exception. Our aim was to evaluate implant reconstruction outcomes in the obese female in the presence of coincident surgical risk factors and identify potential risk‐reducing interventions. A review of consecutive obese women (BMI ≥ 30) who underwent mastectomy and implant breast reconstruction was performed. Patient demographics, comorbidities, oncologic treatments, and reconstructive procedures and their complications were recorded. A total of 151 women (242 breast reconstructions) were included with mean follow‐up of 28 months. Average BMI was 36. Eighty percent of cases were immediate and 20% delayed. ADMs were utilized in 58% of cases. About 25% of patients had diabetes with one‐third achieving perioperative glycemic control. About 18% of women were active smokers, and 33% had radiotherapy. Major and minor complications occurred in 42% and 11% of patients, respectively. About 24% of reconstructed breasts required implant removal. Obese patients with prior radiation were three times as likely to develop infection (P = 0.008) and 2.5× as likely to undergo explantation (P = 0.002). Skin flap necrosis was three times as likely in obese smokers (P = 0.01). Increased rates of wound breakdown were identified in obese patients with increasing age (P = 0.005), smoking (P = 0.0035), and radiation (P = 0.023). In the obese radiated and smoking patient subgroups, surgical modifications (use of autologous tissue, delayed breast reconstruction timing, and no ADM) were associated with reduction in the relative risk for implant complications. While obesity alone increases implant breast reconstruction complication rates, the presence of additional risk factors compounds these rates. The use of surgical modifications may reduce the occurrence of perioperative complications in the obese female with coincident surgical risk factors undergoing implant breast reconstruction.

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Section: Introductionmentioning

confidence: 76%

Operative risk stratification in the obese female undergoing implant‐based breast reconstruction

2019

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“…For example, Brooks and colleagues evaluated 560 women who underwent tissue expander/implant reconstruction at the Cleveland Clinic between 2000 and 2006 (19). Major complications requiring additional operative interventions occurred in 45.4% of radiated breasts in comparison to 21.2% in non-radiated breasts.…”

Section: Discussionmentioning

confidence: 99%

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

Chetta

Aliu

Zhong

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Objective Implant based reconstruction rates have risen among radiation treated breast cancer patients in the United States. The aim of this study is to assess the morbidity associated with various breast reconstruction techniques in radiated patients. Methods From the MarketScan Commercial Claims and Encounters database, we selected breast cancer patients who had undergone mastectomy, radiation and breast reconstruction from 2009 to 2012. We obtained demographic and clinical treatment data including data on the timing of radiation relative to breast reconstruction. We recorded complications and failures after implant and autologous reconstruction. We developed a multivariable logistic regression model with postoperative complications as the dependent variable and patient demographic and clinical variables including method and timing of reconstruction as independent variables. Results 4,781 radiated patients who met the inclusion criteria were selected. A majority of the patients (n=3,846, 80%) were reconstructed with implants. Overall complication rates were 45.3% and 30.8% for patients with implant and autologous reconstruction respectively. Failure of reconstruction occurred in 29.4% of patients with implant reconstruction compared to 4.3% for patients with autologous reconstruction. In multivariable logistic regression, radiated patients with implant reconstruction had 2 times the odds of having any complication and 11 times the odds of failure relative to patients with autologous reconstruction. Conclusions Implant based breast reconstruction in the radiated patient, though popular, is associated with significant morbidity. Failures of reconstruction with implants in these patients approach 30% in the short term, suggesting a need for careful shared decision-making with full disclosure of the potential morbidity.

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“…The risk factors for complications of implant‐based reconstruction were higher body mass index, old age, delayed reconstruction and radiotherapy . The risk factors for autologous tissue reconstruction were higher body mass index, smoking and diabetes .…”

Section: Discussionmentioning

confidence: 99%

“…The risk factors for complications of implant-based reconstruction were higher body mass index, old age, delayed reconstruction and radiotherapy. [17][18][19][20] The risk factors for autologous tissue reconstruction were higher body mass index, smoking and diabetes. 6,17 Tumour stage and smoking are important factors for Baker grades 3 and 4 capsular contracture following immediate reconstruction with radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Can intensity‐modulated radiation therapy spare the central flapped area while encompassing the target volume in radiotherapy after immediate breast reconstruction?

et al. 2013

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

Cited by 44 publications

References 21 publications

Operative risk stratification in the obese female undergoing implant‐based breast reconstruction

Operative risk stratification in the obese female undergoing implant‐based breast reconstruction

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

Can intensity‐modulated radiation therapy spare the central flapped area while encompassing the target volume in radiotherapy after immediate breast reconstruction?

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