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A Multidisciplinary Protocol for Planned Skin-Preserving Delayed Breast Reconstruction for Patients with Locally Advanced Breast Cancer Requiring Postmastectomy Radiation Therapy: 3-Year Follow-Up

Kronowitz, Steven J. M.D.; Lam, Candace M.S.; Terefe, Welela M.D.; Hunt, Kelly K. M.D.; Kuerer, Henry M. M.D., Ph.D.; Valero, Vicente M.D.; Lance, Samuel M.S.; Robb, Geoffrey L. M.D.; Feng, Lei M.S.; Buchholz, Thomas A. M.D.

Plastic and Reconstructive Surgery: June 2011 - Volume 127 - Issue 6 - p 2154-2166
doi: 10.1097/PRS.0b013e3182131b8e
Breast: Original Articles

Background: The authors examined the safety of a protocol for planned skin-preserving delayed breast reconstruction after postmastectomy radiotherapy with placement of a tissue expander for patients with locally advanced breast cancer (stages IIB and III).

Methods: The authors compared 47 patients treated according to the protocol between December 2003 and May 2008 with 47 disease-stage-matched control patients who underwent standard delayed reconstruction after postmastectomy radiotherapy (no skin preservation or tissue expander) during the same period.

Results: Protocol-group complication rates were 21 percent for skin-preserving mastectomy and placement of the expander (stage 1), 5 percent for postmastectomy radiotherapy, 25 percent for expander reinflation after radiotherapy, and 24 percent for skin-preserving delayed reconstruction. The complication rate for standard delayed reconstruction was 38 percent. Tissue-expander loss rates were 32 percent overall, 9 percent for stage 1, 5 percent for postmastectomy radiotherapy, and 22 percent for reinflation. Wound-healing complications after reconstruction occurred in 3 percent of protocol-group and 10 percent of control-group patients. The median follow-up time for patients still alive at last follow-up was 40 months (range, 8.5 to 85.3 months). Three-year recurrence-free survival rates were 92 percent (95 percent CI, 83 to 100 percent) and 86 percent (95 percent CI, 76 to 98 percent) for the protocol and control groups, respectively (p = 0.87).

Conclusion: In patients with locally advanced breast cancer, skin-preserving mastectomy with a deflated tissue expander on the chest wall during postmastectomy radiotherapy does not increase locoregional recurrence risk and is associated with lower complication rates of definitive reconstruction.

Houston, Texas

From the Departments of Plastic Surgery, Radiation Oncology, Surgical Oncology, Breast Medical Oncology, and Biostatistics, University of Texas M. D. Anderson Cancer Center.

Received for publication June 17, 2010; accepted November 5, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Steven J. Kronowitz, M.D., Department of Plastic Surgery, Box 443, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030,

©2011American Society of Plastic Surgeons