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Increasing the Time to Expander-Implant Exchange after Postmastectomy Radiation Therapy Reduces Expander-Implant Failure

Peled, Anne Warren M.D.; Foster, Robert D. M.D.; Esserman, Laura J. M.D., M.B.A.; Park, Catherine C. M.D.; Hwang, E. Shelley M.D., M.P.H.; Fowble, Barbara M.D.

Plastic & Reconstructive Surgery: September 2012 - Volume 130 - Issue 3 - p 503–509
doi: 10.1097/PRS.0b013e31825dbf15
Breast: Original Articles

Background: Increased rates of complications can occur when postmastectomy radiation therapy is required after immediate expander-implant breast reconstruction. The sequence and timing of tissue expansion and implant exchange with regard to postmastectomy radiation therapy may impact complication rates.

Methods: A prospectively maintained database of patients undergoing mastectomy and immediate reconstruction was queried for patients who underwent postmastectomy radiation therapy. The authors' protocol is to complete tissue expansion before radiation, irradiate the fully inflated expander, and then perform expander-implant exchange. Starting in 2009, the authors refined their protocol by increasing the time interval between completion of radiation therapy and expander-implant exchange from 3 months to 6 months as a strategy to reduce surgical complications. For analysis, patients were divided into two cohorts based on whether expander-implant exchange was performed less than 6 months or more than 6 months after radiation. The primary outcome was expander-implant failure, defined as device removal without concurrent replacement.

Results: Eighty-eight patients met selection criteria; 49 (55.7 percent) had expander-implant exchange within 6 months of completing radiation therapy (mean, 3.4 months; range, 1.2 to 5.8 months), and the rest had at least a 6-month interval (mean, 8.6 months; range, 6.1 to 17.1 months). Risk factors for postoperative complications were equivalent between cohorts. Overall expander-implant failure was 15.9 percent; failure was significantly higher in the cohort with less than 6 months' time before exchange (22.4 percent versus 7.7 percent, p = 0.036).

Conclusion: Delaying expander-implant exchange for at least 6 months after the completion of postmastectomy radiation therapy can significantly reduce expander-implant failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

San Francisco, Calif.; and Durham, N.C.

From the Divisions of Plastic Surgery and Breast Surgery, Department of Surgery, and the Department of Radiation Oncology, University of California, San Francisco; and the Department of Surgery, Duke University Medical Center.

Received for publication February 1, 2012; accepted April 3, 2012.

Presented at the 62nd Annual Meeting of the California Society of Plastic Surgeons, in Coronado, California, May 25 through 28, 2012.

Disclosure: None of the authors has any financial disclosures related to this work.

Anne Warren Peled, M.D.; 505 Parnassus Avenue, Suite M593, University of California, San Francisco, San Francisco, Calif. 94143, anne.peled@ucsfmedctr.org

©2012American Society of Plastic Surgeons