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Timing of Radiation Therapy and Outcomes in Tissue Expander/Implant Breast Reconstruction
Aaron Kearney B.S., Matthew Brown M.D., Hooman Soltanian M.D.
Case Western Reserve University Department of Plastic Surgery
2014-02-28
Presenter: Aaron Kearney B.S.
Affidavit:
I affirm that the resident and medical student authors were primarily involved in every phase this project; the project is chiefly their original work.
Director Name: Hooman Soltanian, M.D.
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
BACKGROUND
Limited data exist regarding the effect of radiation timing on complications of tissue expander/implant breast reconstruction (TE/I). This study seeks to compare outcomes of TE/I in patients classified based on their exposure to and timing of radiation therapy.
METHODS
The records of a single surgeon were reviewed from 2007 to 2013. All patients undergoing TE/I divided into 1 of 3 groups based on their radiation exposure: after mastectomy at the time of reconstruction (Current), previous breast conservation therapy (Prior), and no radiotherapy (None). Comparison was done using the Chi Square or Fisher's Exact test for categorical variables and one-way ANOVA with a Tukey post-hoc test for continuous variables. All analyses were run in SPSS v. 21 (IBM Corp.).
RESULTS
210 patients (292 breasts) were included in the analysis. Current and Prior patients were significantly less likely to complete second stage reconstruction. Current patients were more likely than None patients to experience expander infection (20.0% vs. 2.6%, p = .001) and expander removal (25.7% vs. 8.3%, p = .007). Patients with prior radiation exposure were more likely than those with no radiation exposure to undergo conversion to tissue flap reconstruction due to a complication (10.5% vs. 0.6%, p = .031).
CONCLUSIONS
This study supports the relative safety of TE/I in patients who have received radiation therapy. The added risk should be discussed with the patients during the informed consent process. Differences in rates of expander infection, expander removal, and conversion to tissue flap reconstruction represent potential areas for further research.
