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Immediate Implant-Based Breast Reconstruction following Total Skin-Sparing Mastectomy: Defining the Risk of Preoperative and Postoperative Radiation Therapy for Surgical Outcomes

Sbitany, Hani M.D.; Wang, Frederick M.D.; Peled, Anne W. M.D.; Lentz, Rachel M.D.; Alvarado, Michael M.D.; Ewing, Cheryl A. M.D.; Esserman, Laura J. M.D., M.B.A.; Fowble, Barbara M.D.; Foster, Robert D. M.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 396–404
doi: 10.1097/PRS.0000000000000466
Breast: Original Articles

Background: Radiation therapy is increasingly used in breast cancer therapy. With total skin-sparing mastectomy and nipple/areola complex preservation, defining the risks of various treatment regimens for morbidity is important, in the setting of immediate prosthetic reconstruction. The authors assessed the effects of premastectomy and postmastectomy radiation therapy on outcomes in total skin-sparing mastectomy and immediate prosthetic reconstruction.

Methods: All patients undergoing total skin-sparing mastectomy and immediate prosthetic reconstruction at the authors' institution between 2006 and 2012 were identified. Cohort 1 included patients undergoing total skin-sparing mastectomy and reconstruction with no radiation. Cohort 2 included patients with a prior history of radiation before total skin-sparing mastectomy and reconstruction. Cohort 3 included patients undergoing radiation after total skin-sparing mastectomy and reconstruction.

Results: A total of 580 patients underwent 903 breast reconstructions following total skin-sparing mastectomy. Cohort 1 included 727 breasts, cohort 2 included 63 breasts, and cohort 3 included 113 breasts. Any radiation delivery caused an increased rate of infection requiring antibiotics (21.6 percent, p = 0.00) and an increased risk of expander/implant loss (18.75 percent, p = 0.00). Cohort 2 had a higher risk of wound breakdown (p = 0.012). All cohorts showed similar low rates of nipple/areola necrosis.

Conclusions: Both preoperative and postoperative radiation following total skin-sparing mastectomy and immediate prosthetic reconstruction result in higher, but acceptable, complication risks. Complications related to nipple/areola preservation are similar to those in nonradiated patients and in those undergoing skin-sparing mastectomy. Thus, nipple/areola complex preservation is safe in women undergoing radiation therapy.


San Francisco, Calif.

From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, and the Department of Radiation Oncology, University of California, San Francisco.

Received for publication January 6, 2014; accepted February 24, 2014.

Disclosures: Hani Sbitany, M.D., is a member of the speaker’s bureau for LifeCell Corporation. He did not receive any compensation or financial support for this study. The remaining authors have no financial interest in any of the products or devices mentioned in this article. No outside funding was received.

Hani Sbitany, M.D., 505 Parnassus Avenue, Suite M-593, San Francisco, Calif. 94143,

©2014American Society of Plastic Surgeons