Irradiated Autologous Breast Reconstructions: Effects of Patient Factors and Treatment Variables

University of Rochester, Rochester, New York, United States
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 03/2010; 126(1):12-6. DOI: 10.1097/PRS.0b013e3181da878f
Source: PubMed


Postmastectomy irradiation often negatively impacts breast reconstruction outcomes. Further investigation is necessary to recognize factors contributing to adverse results. The purpose of this study was to (1) accurately assess the impact of radiation on autologous breast reconstruction and (2) identify patient and treatment factors affecting reconstructive outcomes.
One hundred twenty-six patients were considered after postmastectomy breast reconstruction and irradiation. The records of 76 patients were studied after excluding for radiation therapy before reconstruction, complications before irradiation, implant reconstruction, mastectomy for recurrent disease, and history of cancer. Patient demographics and comorbidities, operative details, adjuvant therapy, and treatment outcomes were assessed.
Seventy-six patients underwent autologous microsurgical breast reconstruction. Complications occurred in 53 patients (70 percent) 7.2 +/- 6 months after irradiation; 36 cases (47 percent) required reoperation for postirradiation effects. Parenchymal complications (fat necrosis or parenchymal fibrosis) were noted in 19.7 percent, skin complications (tissue envelope retraction or hypertrophic scarring) were recorded in 30.3 percent, and general dissatisfaction (physician or patient dissatisfaction) arose in 27.6 percent of patients. Parenchymal complications were associated with smoking (odds ratio, 9.3; p = 0.03), type II diabetes mellitus (odds ratio, 8.5; p = 0.02), and age (odds ratio, 1.1; p = 0.02). Neoadjuvant chemotherapy increased the development of complications (odds ratio, 4.4; p = 0.04), particularly skin changes (odds ratio, 2.4; p = 0.01).
Patient-specific factors, including diabetes mellitus and smoking, increase the risk of postirradiation parenchymal changes, and neoadjuvant chemotherapy is associated with a greater than twofold increase in skin complications. Breast reconstruction followed by irradiation can be successful, but patients with specific risks should be aware of increased complication rates.

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    • "Despite a proven oncologic benefit in select patients, post-mastectomy radiation therapy (PMRT) will often have a negative impact on aesthetic outcomes following breast reconstruction [1,2,3]. Reported adverse effects include but are not limited to capsular contracture, breast distortion, infection, parenchymal atrophy, and fat necrosis [4]. Efforts to better understand the relationship between these radiation related morbidities and various patient/treatment factors have been investigated in an effort to improve surgical and aesthetic outcomes. "
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