Journal
CLINICAL BREAST CANCER
Volume 12, Issue 6, Pages 428-432Publisher
CIG MEDIA GROUP, LP
DOI: 10.1016/j.clbc.2012.09.001
Keywords
Cosmesis; Mastectomy; Postmastectomy radiation; Reconstruction failure; Tissue expanders
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Postmastectomy radiation therapy (PMRT) can increase the rate of breast reconstruction complications and failures. There are limited data on immediate breast reconstruction with tissue expanders (TEs)/implants followed by irradiation. We report on a large cohort of women who received immediate breast reconstruction with TEs/implants and then were treated with irradiation. Good cosmesis was achieved in the majority of women, with an acceptable risk of expander or implant loss. Background: This study reports the rate of breast reconstruction failure and cosmetic outcomes after postmastectomy radiation therapy (PMRT) with temporary tissue expanders (TEs) or implants in place. Patients and Methods: Ninety-four patients underwent mastectomy (93 unilateral, 1 bilateral; 95 cases total) and immediate TE reconstruction followed by PMRT. Ninety TEs and 5 permanent implants were irradiated. All patients received a dose of 5400 cGy given in 180-cGy fractions to the reconstructed breast. Twenty-one patients (22%) received tangents alone and 74 patients (78%) were treated with tangents and a supraclavicular field using a monoisocentric technique. Bolus was used in 91 patients (96%). Eighty-eight patients (93%) received chemotherapy and 78 patients (82%) received endocrine therapy. Results: With a median follow-up of 24.1 months, 19 patients (20%) experienced failure of reconstruction. The 1-, 2-, and 3-year actuarial rate of reconstruction failure was 9.7%, 19.3%, and 25.5%, respectively. Infection was the most common cause of failure. Of the 19 failures, 8 patients underwent salvage procedures with flap reconstruction. Univariate analysis was performed examining age, chemotherapy use, hormone therapy use, use of a supraclavicular field, smoking status, diabetes, hypertension, and menopausal status. No risk factors were found to be associated with reconstruction failure. In patients who did not experience reconstruction failure, good/excellent cosmesis was observed in 75% of patients. Conclusion: In the current series of women with a high risk of locoregional recurrence, PMRT with a TE/implant in place provides good cosmesis in the majority of women, with an acceptable risk of expander or implant loss.
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