Complications From Postmastectomy Radiation Therapy in Patients Undergoing Immediate Breast Reconstruction: A Population-Based Study

Doherty, Chris; McClure, Andrew; Baxter, Nancy N.; Brackstone, Muriel

doi:10.1016/j.adro.2022.101104

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…It can also lead to capsular contraction, which mandates the removal of the implant. Patients undergoing radiation therapy after reconstructive surgery need to be advised about the possibility of additional corrective surgery [35].…”

Section: Impact Of Radiotherapy In Surgical Options and Resultsmentioning

confidence: 99%

Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results

Simion,

Petrescu,

Chitoran

et al. 2024

Life

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(1) Importance of problem: Breast cancer accounted for 685,000 deaths globally in 2020, and half of all cases occur in women with no specific risk factor besides gender and age group. During the last four decades, we have seen a 40% reduction in age-standardized breast cancer mortality and have also witnessed a reduction in the medium age at diagnosis, which in turn means that the number of mastectomies performed for younger women increased, raising the need for adequate breast reconstructive surgery. Advances in oncological treatment have made it possible to limit the extent of what represents radical surgery for breast cancer, yet in the past decade, we have seen a marked trend toward mastectomies in breast-conserving surgery-eligible patients. Prophylactic mastectomies have also registered an upward trend. This trend together with new uses for breast reconstruction like chest feminization in transgender patients has increased the need for breast reconstruction surgery. (2) Purpose: The purpose of this study is to analyze the types of reconstructive procedures, their indications, their limitations, their functional results, and their safety profiles when used during the integrated treatment plan of the oncologic patient. (3) Methods: We conducted an extensive literature review of the main reconstructive techniques, especially the autologous procedures; summarized the findings; and presented a few cases from our own experience for exemplification of the usage of breast reconstruction in oncologic patients. (4) Conclusions: Breast reconstruction has become a necessary step in the treatment of most breast cancers, and many reconstructive techniques are now routinely practiced. Microsurgical techniques are considered the “gold standard”, but they are not accessible to all services, from a technical or financial point of view, so pediculated flaps remain the safe and reliable option, along with alloplastic procedures, to improve the quality of life of these patients.

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Section: Impact Of Radiotherapy In Surgical Options and Resultsmentioning

confidence: 99%

Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results

Simion,

Petrescu,

Chitoran

et al. 2024

Life

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“…It is widely accepted that PMRT following breast reconstruction is associated with an increased risk of secondary breast reconstruction surgery [24]. A large retrospective study on more than 2300 patients demonstrated that patients who received PMRT within 10 months of surgery were significantly more likely to undergo secondary breast reconstruction (57.1%), compared to 36.6% of patients who received no radiation therapy [25]. Another 10-year study on 1788 patients who received implant-based breast augmentation without radiation reported a revision rate of 31.5% [18].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction

Vinsensia,

Schaub,

Meixner

et al. 2024

Cancers

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Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. Methods: We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0–50.4 Gy in 25–28 fractions. Capsular contracture was categorized according to the Baker Classification for Reconstructed Breasts. Results: After a median follow-up of 22 months, the incidence of clinically relevant capsular contracture (Baker III–IV) was 22.9%. Overall, capsular contracture (Baker I–IV) occurred in 56 patients (47.5%) after a median of 9 months after PMRT. The rate of reconstruction failure/implant loss was 25.4%. In the univariate analysis, postoperative complications (prolonged pain, prolonged wound healing, seroma and swelling) and regional nodal involvement were associated with higher rates of capsular contracture (p = 0.017, OR: 2.5, 95% CI: 1.2–5.3 and p = 0.031, respectively). None of the analyzed dosimetric factors or the implant position were associated with a higher risk for capsular contracture. Conclusion: Postoperative complications and regional nodal involvement were associated with an increased risk of capsular contracture following breast reconstruction and PMRT, while none of the analyzed dosimetric factors were linked to a higher incidence. Additional studies are needed to identify further potential risk factors.

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“…Prior studies that caution against radiation of the autologous flap warn against deformities related to fat necrosis, tissue fibrosis, and flap contracture, as well as increased need for reoperation (Clarke‐Pearson et al, 2013; Craig et al, 2018; Doherty et al, 2023; Rogers & Allen, 2002; Spear et al, 2005). These contour deformities result in revision surgeries for asymmetry, but in our cohort there was no significant difference in revision surgeries between the PreFlap and PostFlap cohorts, suggesting no significant increase in irregularities warranting revision despite radiation of the flap.…”

Section: Discussionmentioning

confidence: 99%

The impact of post‐mastectomy radiation timing on overall outcomes of autologous free‐flap breast reconstruction

et al. 2023

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BackgroundThe optimal timing of post‐mastectomy radiation therapy (PMRT) in autologous breast reconstruction is controversial. Our study compares overall reconstructive outcomes in patients who received post‐mastectomy radiation therapy either before or after the autologous flap.MethodsA single‐center retrospective review was performed for patients who underwent free flap breast reconstruction and post‐mastectomy radiation from January 2004 through January 2021. Demographic, intraoperative, and post‐operative variables were recorded.ResultsA total of 452 free flaps were identified, and 82 underwent PMRT. 59.8% were radiated with an expander prior to free flap surgery (PreFlap), and 40.2% flaps underwent PMRT (PostFlap). PostFlap patients were significantly younger (43.0 vs. 47.9 years, p = .016). There were no significant differences in free flap outcomes between the two cohorts including thrombosis, venous congestion, flap loss, takebacks, fat necrosis, seroma, or infection. Mastectomy skin flap necrosis was significantly higher in the PostFlap cohort (9.1% vs. 0%, p = .032), but nipple necrosis rates did not differ. There were no significant differences in number or need for revision surgeries, fat necrosis, or fat grafting between groups. However, there were significantly more total reconstructive complications, including infection and wound breakdown, experienced by the PreFlap cohort (46.9% vs. 24.2%, p = .038).ConclusionsTiming of PMRT did not impact free flap outcomes, but those who had the expander radiated experienced significantly more complications overall. For the 34.7% of patients in the preFlap group who planned for autologous reconstruction form initial consultation, radiation after the flap may have improved their overall outcomes. As added complications cause delays in cancer therapy and final reconstruction, our results suggest that PMRT of the flap when possible may improve the overall experience for breast cancer patients.

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Complications From Postmastectomy Radiation Therapy in Patients Undergoing Immediate Breast Reconstruction: A Population-Based Study

Cited by 7 publications

References 27 publications

Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results

Breast Reconstruction following Mastectomy for Breast Cancer or Prophylactic Mastectomy: Therapeutic Options and Results

Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction

The impact of post‐mastectomy radiation timing on overall outcomes of autologous free‐flap breast reconstruction

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