Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy

Journal Article · Wed Jul 01 04:00:00 EDT 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.02.031· OSTI ID:22462358

Fowble, Barbara ^[1]; Park, Catherine ^[1]; Wang, Frederick; Peled, Anne ^[2]; Alvarado, Michael; Ewing, Cheryl; Esserman, Laura ^[3]; Foster, Robert; Sbitany, Hani ^[2]; Hanlon, Alex ^[4]

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1. Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States)
2. Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States)
3. Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California (United States)
4. University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (United States)

Objectives: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Methods and Materials: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Results: Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. Conclusions: RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and with a preferred interval of 6 months to exchange.

• OSTI ID: 22462358
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 92; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANIMAL TISSUES
CHEMOTHERAPY
DOXORUBICIN
FAILURES
IMPLANTS
MAMMARY GLANDS
MULTIVARIATE ANALYSIS
MUSCLES
NEOPLASMS
PATIENTS
RADIOTHERAPY
SKIN
WOMEN