Impact of Sequencing of Postmastectomy Radiotherapy and Breast Reconstruction on Timing and Rate of Complications and Patient Satisfaction

Adesiyun, Tolulope; Lee, Bernard T.; Yueh, Janet H.; Chen, Chen; Colakoğlu, Salih; Anderson, K.; Nguyen, Minh Doan T.; Recht, Abram

doi:10.1016/j.ijrobp.2010.02.039

Cited by 42 publications

(16 citation statements)

References 30 publications

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“…But as an indication of this consensus of a reasonable interval to radiation, a benchmark used in an ongoing major cooperative group clinical trial is to begin radiation within 12 weeks of the last breast cancer surgery for patients treated with neoadjuvant chemotherapy or within 12 weeks of the last dose of adjuvant chemotherapy . Longer intervals have been reported in clinical practice due to wide variations between patients in timing of reconstruction, radiation, and chemotherapy . In this study, the median duration from PI exchange to completion of XRT was 75 days—well within this standard.…”

Section: Discussionsupporting

confidence: 62%

The Timing of Breast Irradiation in Two-Stage Expander/Implant Breast Reconstruction

et al. 2016

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Certain patients who initiate expander/implant (E/I) reconstruction following mastectomy may require radiation therapy (XRT). XRT may be delivered during the tissue expander (TE) expansion process or after exchange for a permanent implant (PI). We studied a series of women treated with E/I reconstruction and XRT to determine whether there is a difference in complication rates between those who had XRT to the TE versus PI. All two-stage E/I reconstructions at our institution from April 2005 to January 2013 were reviewed to identify patients who underwent XRT after TE placement. Our database was queried for reconstructive details, oncologic treatment, and complications. Statistical analyses were performed to establish significance of complication rate differences. Fifty-two patients underwent XRT after TE placement, 42 of which had XRT to the TE and 11 of which had XRT to the PI. The major complication rates (complications requiring emergent reoperation/readmission) were 27% versus 0% (p = 0.05) for XRT to the TE versus XRT to the PI, but there were no significant differences in minor complication rates (outpatient complications). Specifically, the rates of Grade 3/4 capsular contracture were similar between the two groups, 27% for the XRT to the TE group and 36% for the XRT to the PI group. Radiation of the PI versus radiation of the TE did not result in significant differences in overall surgical complication rates but had fewer major complications and no implant failures. Other factors must also be considered, such as patient preference, risk of cancer reoccurrence, and cosmesis. It is essential for a patient to have a team of a plastic surgeon and radiation, surgical, and medical oncologists working together to achieve each patient's goals.

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Section: Discussionsupporting

confidence: 62%

The Timing of Breast Irradiation in Two-Stage Expander/Implant Breast Reconstruction

et al. 2016

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“…20 Capsular contracture is a well-recognized late complication of implant-based reconstruction and can take 5 to 7 years to develop. 7 Although capsular contracture can occur in the absence of radiation in patients with implant reconstructions, radiotherapy is a known risk factor for increased capsular contracture rates.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Cordeiro

Disa

et al. 2011

Cancer

116

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BACKGROUND: Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated. METHODS: Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR. RESULTS: Median follow-up was 86 months (range, 11-161 months). The 7-year PIRRfree rate was 71% (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1% (21), and removal was 13.3% (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81% and overall survival 93%. CONCLUSIONS: Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population. Cancer 2012;118:2552-

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“…Only a single study also evaluated other abdominal flaps (i.e., DIEP and SIEA flap reconstruction). 17 All were cohort trials, mostly conducted in North America (n = 11), 9,13,14,17,18,[24][25][26][27][28][29] with one each from Croatia/Austria, 15 Italy, 30 and the United Kingdom. 16 The mean follow-up period ranged from 6 months 15 to 60.2 months 18 ( Table 2).…”

Section: Description Of the Included Studiesmentioning

confidence: 99%

“…13,24,26,30 In pooling the estimates on irradiated breasts only, major complications were less frequently reported in breasts reconstructed by means of autologous abdominal tissue compared with tissue expander/ implant (event rates: autologous abdominal tissue, 23 of 130; tissue expander/implant, 26 of 108; relative risk, 0.46; 95 percent CI, 0.29 to 0.73; I 2 = 0 percent) (Fig. 8, below).…”

Section: Impact Of Radiotherapy On the Development Of Complication Bymentioning

confidence: 99%

Safety of Tissue Expander/Implant versus Autologous Abdominal Tissue Breast Reconstruction in Postmastectomy Breast Cancer Patients

Tsoi

Ziolkowski

Thoma

et al. 2014

Plastic and Reconstructive Surgery

112

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Impact of Sequencing of Postmastectomy Radiotherapy and Breast Reconstruction on Timing and Rate of Complications and Patient Satisfaction

Cited by 42 publications

References 30 publications

The Timing of Breast Irradiation in Two-Stage Expander/Implant Breast Reconstruction

The Timing of Breast Irradiation in Two-Stage Expander/Implant Breast Reconstruction

Long‐term outcomes in breast cancer patients undergoing immediate 2‐stage expander/implant reconstruction and postmastectomy radiation

Safety of Tissue Expander/Implant versus Autologous Abdominal Tissue Breast Reconstruction in Postmastectomy Breast Cancer Patients

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