Saturday, October 12, 2013
INTRODUCTION: Post-mastectomy radiation (PMRT) has become increasingly indicated in patients with advanced breast cancer, and outcomes information is valuable for decision-making.1–3 The objective of this study is to prospectively evaluate long-term outcomes in a large cohort of women who underwent immediate tissue expander/implant reconstruction.
METHODS: A total of 3,982 tissue expander/implant reconstructions were performed in 2,718 patients by a single surgeon from 1992 to 2010. A cohort of 1,557 patients was annually evaluated and patient/implant characteristics, PMRT and complications were prospectively recorded. Outcomes recorded included capsular contracture, rippling, post-exchange cellulitis, implant deflation, implant replacement, implant loss (implant removal without replacement), conversion to flap and aesthetic results. Complication rates were compared between the irradiated and non-irradiated group. Predictors for implant loss were evaluated with logistic regression. Predicted implant replacement and loss rates were examined by radiation status with Kaplan-Meier analysis and log-rank test.
RESULTS: A total of 2,326 breast implant reconstructions with a minimum follow up of 1 year were included. Mean follow up was 57.2 months (range:12-200). Two-hundred ninety one patients received PMRT (12.5%). Severe capsular contracture grade 4 was present in 7.4% of irradiated and 0.6% of the non-irradiated (p<0.01), post-exchange cellulitis in 10.5% and 3.3%(p=0.01), implant replacement in 6.7% and 6.4% (p=NS) and implant loss in 9.1% and 0.7% respectively(p<0.01)(Figure 1). Deflation rates were similar between the groups. Seventy percent of irradiated patients had good to excellent aesthetic result, and 95% would choose implants again. Predicted implant replacement rates at 10 years were similar between groups (p=NS). Predicted implant loss rates were higher for irradiated implants, 14.9% compared to 1.3% for non-irradiated(p<0.01)(Figure 2). Multivariable analysis showed that greater body mass index (OR=1.09, p=0.04), post-exchange cellulitis (OR=32.1, p<0.01) and radiotherapy (OR=8.46, p<0.01) were predictors of implant loss.
CONCLUSION: This is the largest prospective evaluation of long-term outcomes in women with immediate tissue expander/implant breast reconstruction who underwent PMRT. Complication rates are higher for irradiated implants; however, most of the patients have a good to excellent aesthetic result and would choose implants again. Capsular contracture grade 3-4 is the most common complication and occurs in approximately half the irradiated implants. Although radiation is a risk factor for implant removal, a vast majority of patients will preserve their reconstruction at 10 years.
1. Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node–positive premenopausal women with breast cancer. The New England Journal of Medicine. 1997;337:956–962
2. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high–risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. The New England Journal of Medicine. 1997;337:949–955
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3. Chua B, Olivotto IA, Weir L, et al. Increased use of adjuvant regional radiotherapy for node–positive breast cancer in British Columbia. Breast J. 2004;10:38–44