Post-Mastectomy Implant Complications in the Hispanic Breast Cancer Patient Population

Abstract

Background/Aim: The purpose was to analyze the impact of post-mastectomy radiation therapy (PMRT) on implant-based breast reconstruction (IBR) in self-identified Hispanic patients compared to non-Hispanic counterparts. Patients and Methods: We retrospectively reviewed patients who underwent IBR between January 1, 2017 and December 31, 2019 at a single hospital system. Patients were cisgender women, assigned female at birth, 18 years or older, and underwent mastectomy with immediate IBR +/-PMRT. We compared characteristics between Hispanic and non-Hispanic patients, assessing capsular contracture and implant loss rates. Multivariable analysis was performed to identify factors associated with complications. Results: A total of 317 patients underwent mastectomy and reconstruction. Of these patients, 302 underwent a total of 467 mastectomies with IBR, and these 467 procedures were included in the analysis of complications. Complications occurred in 175 breasts (37.5%), regardless of PMRT. Seventy-two of the 302 patients (24%) received PMRT to one breast. The overall rates of capsular contracture, implant loss, and overall complications did not vary significantly between Hispanic and non-Hispanic patients (p=0.866, 0.974, and 0.761, respectively). When comparing only irradiated patients, there was a trend towards increased implant loss and overall complication rates in Hispanic versus non-Hispanic patients (p=0.107 and 0.113, respectively). Following PMRT the rate of any complication was 71% in Hispanic women and 53% in non-Hispanic women. Conclusion: Our study illuminates a trend towards higher complication rates after PMRT in Hispanic versus non-Hispanic patients. Further studies are needed to understand why Hispanic patients may have more side effects from radiation therapy.Breast cancer is the most common type of cancer as well as the leading cause of death in Hispanic women (1, 2). Studies in breast cancer have shown that Hispanic patients are more likely to present with overall later stage at diagnosis (3, 4) when compared to non-Hispanic white patients. Node positive disease increases the likelihood that patients undergoing surgery will be considered for post-mastectomy radiation therapy (PMRT) and be exposed to the potential side effects of radiation therapy. Those belonging to racial or ethnic minority groups are more likely to experience adverse health outcomes, making race and ethnicity important social determinants of health to control for when analyzing complications ( 5). Yet, race and ethnicity as predictive factors of complications have not been included in prior analyses assessing PMRT (5).The primary role of PMRT is to eliminate occult disease, and it has been shown to reduce local recurrence and improve overall survival (OS) in appropriately selected patients (6). Generally, PMRT is reserved for locally advanced disease (T3N1, T4, N2-N3) and is not generally recommended for small, node negative tumors unless there are positive margins or other poor prognostic features. There is still debate regardin...