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
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.
Available from: Maurice Y Nahabedian
- "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 . 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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The technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction.
A retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis.
Patient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P<0.001 and 3.41 vs. 2.79, P<0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P<0.001 and 3.84 vs. 3.06, P<0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P<0.05).
Preservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.
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ABSTRACT: We survey research at the M.I.T. Media Laboratory concerned with accurately modeling, tracking, and interacting with people. Applications include computer animation, user interfaces, and video understanding
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ABSTRACT: Monte Carlo simulation is commonly employed for risk analysis, which evaluates the risk associated with rare events in distribution systems. The traditional approach of Monte Carlo simulation requires a distribution reliability assessment for each sample year. This may be very time-consuming, since hundreds of sample years are necessary to obtain a precise result. This paper presents a linear contribution factor model (LCFM) to simplify the Monte Carlo simulation. The linear model considers three major distribution reliability indices (SAIFI, SAIDI, and MAIFIE) and two failure modes (permanent fault and temporary fault). While the result from the proposed simplified approach is identical to the traditional approach, the simplified approach may reduce the running time by up to 98%.
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