Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: Complications and esthetic results

Purpose: To report complications, failure rate, and esthetic results in patients undergoing immediate breast reconstruction with a tissue expander and implant, with or without adjuvant treatment. Methods and Materials: We reviewed the records of the 77 patients who underwent immediate breast reconstruction with an expander/implant between January 1999 and December 2000. Complications were assessed using the Common Toxicity Criteria, version 2, scale. Esthetic results were assessed by the physician using five criteria. Results: Of the 77 patients, 55 had received adjuvant radiotherapy. The median follow-up was 25 months. Complications appeared to correlate with radiotherapy (14% for nonirradiated patients; 51% for irradiated patients; p = 0.006) and adjuvant chemotherapy (54% with chemotherapy [CHT] vs. 25% without CHT; p = 0.02). Breast reconstruction failed in 21% of patients (9% of nonirradiated patients and 24% of irradiated patients; p = 0.1), and chemotherapy was associated with a worse rate of failure (34 % with CHT vs. 6 % without CHT, p = 0.005). Adjuvant tamoxifen, however, correlated neither with complications (45 % with tamoxifen vs. 39% without; p = 0.15) nor with failure (21% with tamoxifen and 23% without,p = 0.79). Esthetic results were acceptable in 60% of cases. Conclusion: Immediate breast reconstruction with an expander/implant can be considered even for patients requiring adjuvant treatment. However, the complication and failure rates are three times higher after postexpander radiotherapy. (C) 2003 Elsevier Inc.