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Postmastectomy Breast Reconstruction After Previous Lumpectomy and Radiation Therapy: Analysis of Complications and Satisfaction

Khansa, Ibrahim BS*; Colakoglu, Salih MD*; Curtis, Michael S. MD; Yueh, Janet H. MD*; Ogunleye, Adeyemi MD, MSc; Tobias, Adam M. MD*; Lee, Bernard T. MD, FACS*

doi: 10.1097/SAP.0b013e3182166b81
Clinical Paper
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Background: Lumpectomy and radiation therapy (breast conservation therapy [BCT]) are common treatments for early-stage breast cancer. However, many of these patients will require a subsequent salvage mastectomy and reconstruction after a locoregional recurrence. This study examines whether prior BCT leads to higher rates of complications and dissatisfaction with subsequent mastectomy and breast reconstruction.

Methods: All women undergoing initial breast reconstruction at an academic institution were identified (1999–2006). Women who had undergone prior BCT were compared with women without prior BCT. A questionnaire adapted from the Michigan Breast Reconstruction Outcomes Survey was administered. Rates of complications, as well as general and aesthetic satisfaction, were compared between the 2 groups. Multiple logistic regression was used to analyze the effects of prior BCT, age, comorbidities, reconstruction type, and time between radiation and reconstruction.

Results: Overall, 532 women underwent 802 reconstructions, of whom 113 women (137 reconstructions) had prior BCT. Prior BCT did not correlate with higher complication rates (odds ratio [OR] = 1.09, P = 0.690), or lower general or aesthetic satisfaction (OR = 0.84, P = 0.559; OR = 0.91, P = 0.723, respectively); however, there was an increased rate of mastectomy skin flap loss (12.4% vs. 6.8%, P = 0.024). Increasing age was the most significant risk factor for complications and dissatisfaction.

Conclusion: Radiation in the setting of BCT did not increase overall rates of complications or dissatisfaction with subsequent breast reconstruction in our patient population. These patients, however, had a higher incidence of mastectomy skin flap loss. These findings are important for preoperative counseling and intraoperative planning in patients with prior lumpectomy and radiation.

From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †Division of Plastic Surgery, State University of New York-Upstate Medical University, Syracuse, NY; and ‡Department of Surgery, Harlem Hospital Center, Columbia University, New York, NY.

Received January 21, 2011, and accepted for publication, after revision, February 18, 2011.

Supported by Doris Duke Charitable Foundation (to J.H.Y.) and the Peter Jay Sharp Foundation (to S.C., M.S.C., A.M.T., and B.T.L.).

Presented at the Northeastern Society of Plastic Surgeons' 27th Annual Meeting in Washington, DC, October 28–31, 2010.

The authors have no financial interests in this research project or in any of the techniques or equipment used in this study. The authors have no conflicts of interest to disclose.

This study was approved by the Institution Review Board at the Beth Israel Deaconess Medical Center, Boston, MA.

Reprints: Bernard T. Lee, MD, FACS, Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St. Suite 5A, Boston, MA 02215. E-mail: blee3@bidmc.harvard.edu.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.