Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: Complications and esthetic results

Tallet, Agnès; Salem, Naji; Moutardier, Vincent; Ananian, Priscilla; Braud, Anne-Chantal; R, Zalta; Cowen, D.; Houvenaeghel, Gilles

doi:10.1016/s0360-3016(03)00526-1

Cited by 183 publications

(116 citation statements)

References 22 publications

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“…CC was graded according to Baker's modified classification [25], but for a better understanding, we called Baker 1a and 1b, respectively, grade 0 and grade 1 throughout the text. Acute complications were presented partly in a previous article [27], and as they often resolved quickly, they were not presented in this report.…”

Section: Complicationsmentioning

confidence: 74%

Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications

Cowen

Groß

Rouannet

et al. 2010

Breast Cancer Res Treat

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108

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The objective is to prospectively determine the factors responsible for reconstruction failure and capsular contracture in mastectomized breast cancer patients who underwent immediate two-stage breast reconstruction with a tissue expander and implant, followed by radiotherapy. This is a multicenter, prospective, non-randomized study. Between February 1998 and September 2006, we prospectively examined 141 consecutive patients, each of which received an implant after mastectomy, followed by chest wall radiotherapy at 46-50 Gy in 23-25 fractions. Radiotherapy was delivered during immediate post-mastectomy reconstruction. Patients were evaluated by both a radiation oncologist and a surgeon 24-36 months after treatment. The median follow-up duration was 37 months. According to Baker's classification, capsular contracture was grade 0, 1, or 2 in 67.5% of cases; it was grade 3 or 4 in 32.5% of cases. In total, 32 breast reconstruction failures required surgery. In univariate analysis, the following factors were associated with Baker grade 3 and 4 capsular contraction: adjuvant hormone therapy (P = 0.02), the surgeon (P = 0.04), and smoking (P = 0.05). Only one factor was significant in multivariate analysis: the surgeon (P = 0.009). Three factors were associated with immediate post-mastectomy breast reconstruction failure in multiple logistic regression analysis: T3 or T4 tumors (P = 0.0005), smoking (P = 0.001), and pN? axillary status (P = 0.004). Patients with none, 1, 2, or all 3 factors have a probability of failure equal to 7, 15.7, 48.3, and 100%, respectively (P = 3.6 9 10 -6 ). The model accurately predicts 80% of failures. Mastectomy, immediate reconstruction (expander followed by implant), and radiotherapy should be considered when conservative surgery is contraindicated. Three factors may be used to select patients likely to benefit from this technique with a low failure rate.

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Section: Complicationsmentioning

confidence: 74%

Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications

Cowen

Groß

Rouannet

et al. 2010

Breast Cancer Res Treat

Self Cite

108

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“…Our research will allow TPS to accurately calculate dose distribution surrounding the metallic port. Without this information, clinicians may ignore the dose perturbation or prescribe an inaccurate amount of additional dose to compensate for the miscalculated dose shadow, which may either cause the loss of target coverage or increase the risk of complications like capsular contracture since radiation to the breast after reconstruction can significantly increase the rates of these complications 10, 30. The methodology utilized in this study can also be used to investigate other high‐density materials within the patient, e.g., metal implants within chordoma patients, pacemaker, hip prosthesis, dental implants, etc.…”

Section: Resultsmentioning

confidence: 99%

“…Many patients will receive postmastectomy radiotherapy (PMRT) with the temporary tissue expander present, while the tissue expander could negatively impact the effectiveness of PMRT and increase the risk of complications 9, 10. Some physicians felt the reconstructions challenged their ability to deliver effective radiotherapy 6.…”

Section: Introductionmentioning

confidence: 99%

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Yoon

Xie

Heins

et al. 2018

J Applied Clin Med Phys

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The purpose of this study was to model the metallic port in breast tissue expanders and to improve the accuracy of dose calculations in a commercial photon treatment planning system (TPS). The density of the model was determined by comparing TPS calculations and ion chamber (IC) measurements. The model was further validated and compared with two widely used clinical models by using a simplified anthropomorphic phantom and thermoluminescent dosimeters (TLD) measurements. Dose perturbations and target coverage for a single postmastectomy radiotherapy (PMRT) patient were also evaluated. The dimensions of the metallic port model were determined to be 1.75 cm in diameter and 5 mm in thickness. The density of the port was adjusted to be 7.5 g/cm3 which minimized the differences between IC measurements and TPS calculations. Using the simplified anthropomorphic phantom, we found the TPS calculated point doses based on the new model were in agreement with TLD measurements within 5.0% and were more accurate than doses calculated based on the clinical models. Based on the photon treatment plans for a real patient, we found that the metallic port has a negligible dosimetric impact on chest wall, while the port introduced significant dose shadow in skin area. The current clinical port models either overestimate or underestimate the attenuation from the metallic port, and the dose perturbation depends on the plan and the model in a complex way. TPS calculations based on our model of the metallic port showed good agreement with measurements for all cases. This new model could improve the accuracy of dose calculations for PMRT patients who have temporary tissue expanders implanted during radiotherapy and could potentially reduce the risk of complications after the treatment.

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“…Some have described the influence on complication rates of treatment factors such as the use of systemic therapy and type of bolus, as well as patient and tumor-related factors such as smoking, positive lymph node status, and T3/T4 primary tumor size. 10,[12][13][14]18 Another study found no association between these factors and surgical outcomes. 16 We were unable to identify any patient or treatment-related predictors of PIRR.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Existing studies of radiation and immediate reconstruction are confounded by small groups of patients with irradiated implants treated with heterogeneous radiotherapy and surgical sequencing and techniques. [9][10][11][12][13][14][15] In addition, the median follow-ups of these studies were relatively short, and end points were variably defined. These differences led to a wide spectrum of reported complication rates ranging from 5% to 48%, underscoring the need for reliable data with lengthy follow-up in homogeneously treated patients who received immediate implantbased reconstruction and radiation.…”

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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Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: Complications and esthetic results

Cited by 183 publications

References 22 publications

Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications

Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

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

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