After reading this article, participants should be able to: 1. Understand the evidence regarding the timing of expander/implant breast reconstruction in the setting of radiation therapy. 2. Discuss the implications of a patient’s risk factors for possible outcomes and complications of expander/implant breast reconstruction. 3. Implement proper prophylactic antibiotic protocols. 4. Use the guidelines to improve their own clinical outcomes and reduce complications.
In March of 2013, the Executive Committee of the American Society of Plastic Surgeons approved an evidence-based guideline on breast reconstruction with expanders and implants, as developed by a guideline-specific work group commissioned by the society’s Health Policy Committee. The guideline addresses ten clinical questions: patient education, immediate versus delayed reconstruction, risk factors, radiation therapy, chemotherapy, hormonal therapy, antibiotic prophylaxis, acellular dermal matrix, monitoring for cancer recurrence, and oncologic outcomes associated with implant-based reconstruction. The evidence indicates that patients undergoing mastectomy should be offered a preoperative referral to a plastic surgeon. Evidence varies regarding the association between postoperative complications and timing of postmastectomy expander/implant breast reconstruction. Evidence is limited regarding the optimal timing of expand/implant reconstruction in the setting of radiation therapy but suggests that irradiation to the expander or implant is associated with an increased risk of postoperative complications. Evidence also varies regarding the association between acellular dermal matrix and surgical complications in the setting of postmastectomy expander/implant reconstruction. Data support the use of an appropriate preoperative antibiotic, but antibiotics should be discontinued within 24 hours of the procedure, unless a surgical drain is present. Furthermore, postmastectomy expander/implant breast reconstruction does not adversely affect oncologic outcomes.
Arlington Heights, Ill.
From the American Society of Plastic Surgeons.
Received for publication October 4, 2013; accepted November 8, 2013.
A complete list of the guideline authors is as follows: Amy Alderman, M.D., M.P.H.; Loree Kalliainen, M.D.; Amy Ahuja, M.P.H.; Bob Basu, M.D.; Phillip Blondeel, M.D.; Hiram Cody III, M.D.; Diana Frame, M.P.H.; Nolan Karp, M.D.; Carol Lee, M.D.; Valerie Lemaine, M.D., M.P.H.; Raman Mahabir, M.D.; Galen Perdikis, M.D.; Neal Reisman, M.D., J.D.; Karie Rosolowski, M.P.H.; Kathryn Ruddy, M.D., M.P.H.; Mark Schusterman, M.D.; DeLaine Schmitz, R.N., M.S.H.L.; Jaime Schwartz, M.D.; and Jennifer Swanson, B.S., M.Ed.
Disclosure: Dr. Basu has a research support recipient and consultant relationship with LifeCell Corp.; Dr. Karp has a research support recipient relationship with Allergan, Inc.; Dr. Lemaine has a grant recipient relationship with Allergan, Inc.; Dr. Schwartz has a consultant relationship with Mentor Worldwide, LLC, and Covidien. None of the other authors has any relevant disclosures.
Amy Alderman, M.D., M.P.H., 444 East Algonquin Road, Arlington Heights, Ill. 60005-4664