Using Complications Associated With Postmastectomy Radiation and Immediate Breast Reconstruction to Improve Surgical Decision Making

Abstract

Postmastectomy irradiation was associated with a high rate of surgical complications and implant loss among patients who underwent IBR. Determining the number of positive SLNs prior to definitive resection and reconstructive operations may reduce complications and implant loss by guiding surgical decision making. Patients with a negative SLN are unlikely to require PMRT. Those with positive SLN(s) are high-risk IBR candidates with a quantifiable PMRT risk.

Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy: A survey of UK breast surgeons

“…Despite a lack of reported outcomes of a delayed-immediate approach to breast reconstruction [7,16,22,23] this approach is being used widely by more than 70% (105) of UK surgeons. This seems to be driven by the flexibility of being able to choose an appropriate second stage (autologous or implant based).…”

Refinements in the Techniques of 2-Stage Breast Reconstruction

“…This is beneficial as implant-based breast reconstruction in the setting of radiotherapy has been shown to have increased complications and reconstructive failures. [31][32][33][34] The initial use of a tissue expander also provides the patient with adequate time to evaluate all of her reconstructive options. Although not the focus of this article, we found that 15% of all patients desired a different final modality of breast reconstruction than originally planned.…”

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

“…The capsular contracture rate was similar for both groups (65). Retrospective data have shown that upfront staging sentinel lymph node biopsy may be useful in determining the probability of postmastectomy radiotherapy in clinically node-negative patients (66)(67)(68)(69)(70)(71). No randomized controlled trials have been conducted to compare upfront staging with intraoperative staging in the setting of immediate reconstruction.…”