Long‐term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant‐based reconstruction

Abstract

Salvage mastectomy (SM) is the standard of care for patients with local recurrence (LR) after breast conservation therapy (BCT), often with immediate reconstruction. Complications of reconstruction are a concern for these patients, and long‐term data are limited. We sought to compare rates of complications requiring re‐operation (CRR) and reconstruction failure (RF) between autologous reconstruction (AR) and tissue expander/implant reconstruction (TE/I). Patients with locally recurrent breast cancer after BCT, treated with SM and immediate AR or TE/I between 2000 and 2008, were identified. CRR was defined as unplanned return to operating room for wound infection, dehiscence, necrosis (including flap, skin, or fat), hematoma, or hernia (for AR) and extrusion, leak, or capsular contracture (for TE/I). RF was defined as conversion to another reconstruction technique or to flat chest wall. This study included 103 patients with 107 reconstructions. Median follow‐up was 6.6 years. CRR and RF were significantly higher with TE/I (n = 34) compared to AR (n = 73) at 5 years (50.9% vs 25.5%; P = 0.02) and (42.1% vs 5.8%; P < 0.001). On univariate analysis (UVA), TE/I (HR = 2.14; P = 0.02) and diabetes (HR = 5.10; P = 0.007) were significant predictors for CRR. On UVA, TE/I (HR = 7.30; P < 0.001) and older age at reconstruction (HR = 1.03; P = 0.003) were significant predictors for RF. In this population of previously irradiated patients, TE/I was associated with significantly higher CRR and RF. Complications continue to occur up to 10 years after TE/I. AR should be considered in appropriately selected patients, though TE/I may remain a reasonable option in patients without high‐risk factors for surgical complications.

Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

“…These findings are consistent with other reports demonstrating increased rates of reoperation and reconstructive failure with IBR, particularly in the setting of postmastectomy radiation therapy and medical comorbidities. 68…”

“…These findings are consistent with other reports demonstrating increased rates of reoperation and reconstructive failure with IBR, particularly in the setting of postmastectomy radiation therapy and medical comorbidities. 68 Given the relatively weak evidence addressing some outcomes for the choice between IBR and AR and the highly patient preference-sensitive nature of the decisions, 69,70 we encourage clinicians to inform patients about the limitations of existing research. Among the limitations is that very little research has explicitly focused on patients whose mastectomy was performed for prophylactic (and not therapeutic) purposes.…”

3D and 4D Printing in the Fight against Breast Cancer

“…This procedure consists of rebuilding the breast shape using tissue from the patient’s body, usually from the abdomen, back, or gluteus. The main drawback of this technique is that tissue undergoes natural changes, for instance, weight loss or gain; in addition, the recovery is longer, and the procedure is more complex [ 23 , 24 ]. The final step of reconstruction concerns the nipple–areola area.…”

Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?

“…This aspect of AFG is particularly beneficial for patients that have previously been irradiated [ 73 ]. For these patients, the risk of early complications, reconstruction failure, and poor aesthetic results can reach up to 50% [ 77 ]. Carrying out AFG, either before the tissue expander is substituted with the definitive implant or even before the prophylactic mastectomy is performed, significantly improved surgical outcomes [ 78 , 79 , 80 ].…”