Background: An increasing number of women who undergo immediate two-stage tissue expander/implant breast reconstruction will require postmastectomy radiation therapy. An important variable is the timing of radiotherapy relative to surgery. The authors report their experience treating a large consecutive series of patients who underwent postmastectomy radiation therapy to the tissue expander before exchange for a permanent implant.
Methods: Patients who had their tissue expander irradiated before implant exchange were identified. Complications, capsular contracture, revision surgery, and autologous salvage rates of irradiated patients were compared with a control group of nonirradiated patients.
Results: Immediate two-stage tissue expander/implant reconstruction was initiated in 604 patients, with 113 irradiated breasts meeting inclusion criteria. Three hundred thirty-nine nonirradiated breasts constituted the control group. There was a 4.2 increased odds of major complications in the irradiated group, after adjusting for plastic surgeon, age, body mass index, smoking, chemotherapy, and cancerous breast (OR, 4.2; p = 0.001). The grade III and IV capsular contracture rate was significantly higher in the irradiated group compared with the control group (21.7 percent versus 10 percent; p < 0.008). The revision rate in the control group was higher compared with the irradiated group (30.2 percent versus 20.9 percent; p < 0.001).
Conclusions: Postmastectomy irradiation to the tissue expander is associated with high complications; however, these patients have an acceptable capsular contracture rate that compares favorably with other implant-based radiotherapy algorithms. Revision rates were less than expected in irradiated breasts. This study suggests that immediate tissue expander/implant reconstruction is a reasonable surgical option in the setting of postmastectomy radiation therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Vancouver, British Columbia, Canada
From the Division of Plastic and Reconstructive Surgery, University of British Columbia; and the Department of Radiation Oncology and Developmental Radiotherapeutics, British Columbia Cancer Agency.
Received for publication July 10, 2013; accepted January 10, 2014.
Presented at the 48th Annual Meeting of the Canadian Society of Plastic Surgery, in Halifax, Nova Scotia, Canada, June 15, 2010.
Disclosure: Dr. Lennox is a speaker and consultant for LifeCell Corp. and Allergan, Inc. Dr. Tyldesley has investigator funding from the Michael Smith Foundation for Health Research.
Peter A. Lennox, M.D., Plastic and Reconstructive Surgery, University of British Columbia, 777 West Broadway, Suite 1000, Vancouver, British Columbia V5Z 4J7, Canada, firstname.lastname@example.org