Delayed Autologous Breast Reconstruction After Postmastectomy Radiation Therapy

Momoh, Adeyiza O.; Colakoğlu, Salih; Blacam, Catherine de; Gautam, Shiva; Tobias, Adam M.; Lee, Bernard T.

doi:10.1097/sap.0b013e31821ee4b6

Cited by 62 publications

(60 citation statements)

References 17 publications

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“…This may be the result of prolonged inflammatory changes to the skin following radiation that may adversely impact healing and scaring when the reconstruction is performed too early. Despite our observations, Momoh et al [16] failed to identify a statistically significant difference in complications between patients who were reconstructed in less than six months, six to twelve months, or greater than twelve months from PMRT.…”

Section: Discussioncontrasting

confidence: 95%

Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes

et al. 2014

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BackgroundThe technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction.MethodsA retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis.ResultsPatient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P<0.001 and 3.41 vs. 2.79, P<0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P<0.001 and 3.84 vs. 3.06, P<0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P<0.05).ConclusionsPreservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.

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Section: Discussioncontrasting

confidence: 95%

Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes

et al. 2014

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“…Postoperative infection rates were reported in eight studies in the pre-reconstruction group 9, 10, 12, 13, 16-19 and seven in the post-reconstruction group. 4, 5, 13, 18, 19, 22, 24 The pooled rate of postoperative infections was 4% (95% CI, 0.02 – 0.06) in 802 flap reconstructions performed after chest wall radiation versus 6% (95% CI, 0.03 – 0.10) in 213 flaps exposed to radiation.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Morbidity Associated with Autologous Breast Reconstruction Before and After Exposure to Radiotherapy: Are Current Practices Ideal?

et al. 2014

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Background The specific aim of this study was to conduct a systematic review of the literature to assess outcomes data on complications and aesthetic results associated with autologous tissue based breast reconstruction performed prior to or after chest wall irradiation. Methods Studies from a PubMed search that met predetermined inclusion criteria were identified. Complications of interest included partial or total flap loss, fat necrosis, thrombosis, infection, seroma, hematoma, delayed wound healing and flap fibrosis/contracture. Pooled complication rates were calculated. Results A total of 20 articles were included in the study for autologous reconstruction. These primary articles were selected after screening 897 publications, with 6 studies presenting data on pre-reconstruction radiation, 9 studies presenting data on post-reconstruction radiation and 5 studies presenting data on both patient groups. Comparison of pooled complication rates between flaps radiated before or after reconstruction were statistically similar, including total flap loss (1% versus 4%), wound healing complications (10% versus 14%), infection (4% versus 6%), hematoma (2% versus 1%), seroma (4% versus 4%) and fat necrosis (10% versus 13%). The pooled rate of flap contracture and fibrosis was 27% in flap reconstructions exposed to radiation therapy. Statistical evaluation of aesthetic outcomes was impossible due to variability in assessment and reporting methods. Conclusions Review of the current literature suggests similar rates of complications and success rates in autologous breast reconstruction patients exposed to pre-reconstruction or post-reconstruction radiation. Immediate autologous reconstruction should be considered as a viable option even in patients who are likely to require post-mastectomy radiation therapy.

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“…There appears to be little consensus among previous studies on complication rates for breast reconstruction in previously radiated patients. 33–35 …”

Section: Discussionmentioning

confidence: 99%

Complications in Postmastectomy Breast Reconstruction

et al. 2018

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Objective In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population. Summary of Background Data Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. Methods Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis. Procedures included expander/implant, latissimus dorsi (LD), pedicle transverse rectus abdominis musculocutaneous (PTRAM), free TRAM (FTRAM), and deep inferior epigastric perforator (DIEP) techniques. Data were gathered pre- and postoperatively from medical records. Separate logistic regressions were conducted for all complications and major complications (those requiring rehospitalization and/or reoperation) within 1 year. Odds ratios (ORs) were calculated for procedure type, controlling for site, demographic, and clinical variables. Results Complication rates for 2234 patients were analyzed. Compared with expander/implant reconstructions, LD (OR) 1.95, P = 0.026), PTRAM (OR 1.89, P = 0.025), FTRAM (OR 1.94, P = 0.011), and DIEP (OR 2.22, P < 0.001) procedures were associated with higher risks of complications. Significantly higher risks were also associated with older age, higher body mass index (BMI), immediate reconstruction, bilateral procedures, and radiation. For major complications, regression showed significantly greater risks for PTRAM (OR 1.86, P = 0.044) and DIEP (OR 1.75, P = 0.004), than expander/implant reconstructions. Failure rates were relatively low, ranging from 0% for PTRAM to 5.9% for expander/implant reconstructions. Conclusion In this multicenter analysis, procedure choice and other patient variables were significant predictors of 1-year complications in breast reconstruction. These findings should be considered in counseling patients on reconstructive options.

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Delayed Autologous Breast Reconstruction After Postmastectomy Radiation Therapy

Cited by 62 publications

References 17 publications

Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes

Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes

A Systematic Review of Morbidity Associated with Autologous Breast Reconstruction Before and After Exposure to Radiotherapy: Are Current Practices Ideal?

Complications in Postmastectomy Breast Reconstruction

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