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Effects of Radiation Dosage on Prosthetic Breast Reconstruction

Vidya Shankaran, M.D. Dylan Childs, M.D. Douglas Wagner, M.D.
Summa Health System, Akron City Hospital
2013-03-01

Presenter: Vidya Shankaran

Affidavit:
This work has not previously been published or presented. It is the original work of the resident under my guidance.

Director Name: Douglas Wagner, M.D.

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)

Background/Objectives:
Radiation therapy is a widely-used adjunct to surgical treatment for breast cancer. Radiation has numerous short-term and long-term deleterious effects on tissues. Because radiation compromises dermal vasculature and promotes stiff capsule formation, prosthetic breast reconstruction has traditionally been avoided in irradiated patients. Recent case series, however, have shown encouraging results for prosthetic reconstruction in selected, irradiated patients. The goals of this study are to demonstrate 1) radiation dosage and fractionation impact prosthetic reconstruction outcomes, and 2) autologous reconstruction followed by prosthetic placement provides superior outcomes to prosthetic placement alone.

Methods:
The breast cancer radiation protocols in two institutions were reviewed and compared. 200 irradiated breast cancer patients were included in this study. An interim analysis of the first 24 consecutive patients that underwent prosthetic reconstruction was performed. Patients were stratified based on outcomes, including infection, capsular contracture, need for revision, and prosthetic explantation.

Results:
Preliminary data demonstrate an overall success for prosthetic reconstruction of 42%. Success was statistically higher in patients who underwent delayed reconstruction as opposed to immediate reconstruction (56% vs 20%). The use of acellular matrix did not significantly impact reconstruction outcomes. The most consistent success occurred in patients who underwent autologous reconstruction with delayed placement of a prosthetic (83%). The use of a bolus during radiation did not significantly affect outcomes.

Conclusions:
This preliminary study echoes existing data by demonstrating that radiation timing affects reconstructive outcomes. Further analysis will be performed to determine how radiation dosing and fractionation affect prosthetic reconstruction.

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