TRAM Flap Breast Reconstruction After Radiation Treatment

Jk, Williams; Bostwick, John; Jt, Bried; Mackay, G; Landry, Jerome C.; Benton, Joshua

doi:10.1097/00000658-199506000-00014

Cited by 93 publications

(45 citation statements)

References 32 publications

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“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications of the flaps after autologous reconstruction (25), although not all studies agree on this (26,27). However, autologous breast reconstruction provides reduced morbidity than implantbased reconstruction in the setting of postoperative radiotherapy (2,26).…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications after autologous reconstruction (25); however, not all studies are in agreement (26,27). Certain studies show that postoperative radiotherapy to the breast reconstructed with a deep inferior epigastric perforator flap (DIEP) or transverse rectus abdominis myocutaneous (TRAM) flap has no effect on the reconstruction (28,29), while several others show a considerable negative effect on the final results of autologous reconstruction (24,26,(30)(31)(32)(33)(34).…”

Section: The Effect Of Radiotherapy On Breast Reconstructionmentioning

confidence: 99%

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Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: The Effect Of Radiotherapy On Breast Reconstructionmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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“…However, because lymph node metastases may not be detected until mastectomy 5 and because micrometastases may not be detected until the final pathology review, [6][7][8][9] it is often not known until several days after mastectomy whether PMRT will be required. If breast reconstruction is performed at the time of mastectomy and it is determined postoperatively that the patient has lymph node involvement, then PMRT may affect the aesthetic outcome adversely, 1,[10][11][12] and the reconstructed breast may cause technical difficulties with radiation delivery to the internal mammary lymph nodes, resulting in either increased lung dose or inadequate radiation doses to these lymph nodes. 13,14 Conversely, if breast reconstruction is delayed because physicians suspect that the patient may require PMRT, but the review of permanent sections reveals that PMRT is not needed, then the mastectomy skin and the shape of the breast skin envelope will be lost along with the chance of the best possible aesthetic outcome.…”

Section: Delayed-immediate Breast Reconstructionmentioning

confidence: 99%

Advances and surgical decision‐making for breast reconstruction

Kronowitz

Kuerer

2006

Cancer

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In patients who undergo breast reconstruction after mastectomy, choosing the appropriate timing and the best method of reconstruction are essential to optimize outcomes and to minimize the potential for postoperative complications. At The University of Texas M. D. Anderson Cancer Center, the clinicopathologic factors that are used in the surgical decision‐making for breast reconstruction after mastectomy include the breast cancer stage, status of axillary sentinel lymph node, smoking status, body habitus, preexisting scars, prior radiation therapy, and planned or previous chemotherapy. Immediate breast reconstruction after mastectomy is preferable for patients who have a low risk of requiring postmastectomy radiation therapy (PMRT) (Stage I breast cancer). Delayed reconstruction may be preferable in patients who are deemed preoperatively to require PMRT (Stage III breast cancer) to avoid difficulties associated with radiation delivery after an immediate breast reconstruction. In patients who are deemed preoperatively to be at an increased risk of requiring PMRT (Stage II breast cancer), delayed‐immediate breast reconstruction may provide an additional option. The approach to breast reconstruction will need to be adapted to maintain an appropriate balance between minimizing the risk of recurrence and providing the best possible aesthetic outcomes as the indications for PMRT and other treatment modalities continue to change. Cancer 2006. © 2006 American cancer Society.

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“…Numerous publications regarding breast reconstruction following irradiation report that the radiated breast site is more prone to complications than the nonradiated breast (2)(3)(4)(5). Currently, little information has been published regarding reduction mammoplasties performed on women previously treated for breast cancer.…”

mentioning

confidence: 99%

Bilateral reduction mammoplasty following breast cancer: A case-control study

Cin¹,

Knight²,

Whelan³

2012

J Plastic Surgery

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S ymptoms of breast hypertrophy can affect post-treatment breast cancer patients. The true incidence of breast hypertrophy in the breast cancer population is unknown, as is the number of such patients seeking reduction mammoplasty surgery following breast cancer treatment. These patients have usually undergone lumpectomies followed by postoperative radiation therapy and chemotherapy. Although there can be changes in the shape and size of the treated breast as a result of lumpectomy and radiation, it is usually minimal in nature, resulting in, at most, asymmetry (1,2). In the macromastic patient, symptoms of interscapular back pain, prominent shoulder grooving, and intertrigo along the inframammary folds or between the breasts remain despite the described changes to the cancer-afflicted breast.Numerous publications regarding breast reconstruction following irradiation report that the radiated breast site is more prone to complications than the nonradiated breast (2-5). Currently, little information has been published regarding reduction mammoplasties performed on women previously treated for breast cancer. The radiated breast is expected to exhibit a likelihood of delayed wound healing, increased postoperative complications and less pleasing final results. In addition, it is unclear whether reduction mammoplasty in the radiated breast can be safely performed without interfering with mammography and cancer surveillance. We sought to review the outcomes of patients who underwent bilateral reduction mammoplasty following lumpectomy and radiation for breast cancer. The primary focus of the present study was the subsequent complications and need for additional surgery in this (particular?) patient population. MethodsAfter approval from the Hamilton Health Sciences Research Ethics Board, a retrospective search was conducted using the health records of Hamilton Health Sciences, McMaster University and the Juravinski Cancer Centre (Hamilton, Ontario) to identify patients who underwent lumpectomy and radiation (with or without chemotherapy) for breast cancer with subsequent bilateral reduction mammoplasty between 1980 and 2007. Patients who had undergone bilateral or unilateral reduction mammoplasty surgery before lumpectomy and radiation treatment, breast augmentation or lumpectomy alone were excluded from the study. PurPose: Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed. Methods: A matched case-control study with patients serving as their own control (treated breast cancer breasts were 'cases', healthy breasts were 'controls') was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri-and postoperative complications were collected. Measured outcome...

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TRAM Flap Breast Reconstruction After Radiation Treatment

Abstract: In this, the largest reported series, radiation therapy was associated with increased fat necrosis and major infection. The use of the TRAM flap was not found to be prohibitive in radiated patients and should still be the first choice in this subgroup of patients.

Cited by 93 publications

References 32 publications

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Advances and surgical decision‐making for breast reconstruction

Bilateral reduction mammoplasty following breast cancer: A case-control study

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