Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Cancer (Impact Factor: 4.89). 05/2012; 118(9):2552-9. DOI: 10.1002/cncr.26521
Source: PubMed


Breast reconstruction with tissue expander (TE)/permanent implant (PI) followed by postmastectomy radiation (PMRT) is an increasingly popular treatment for breast cancer patients. The long-term rates of permanent implant removal or replacement (PIRR) and clinical outcomes in patients treated with a uniform reconstructive surgery and radiation regimen were evaluated.
Between 1996 and 2006, 1639 patients with stage II-III breast cancer received modified radical mastectomy (MRM) at Memorial Sloan-Kettering Cancer Center. A total of 751 received TE placement at the time of mastectomy. Of these, 151 patients went on to receive chemotherapy and exchange of the TE for a permanent implant, followed by PMRT. Clinical outcomes and PIRR-free rates were estimated by Kaplan-Meier methods. Cox regression model was used to examine patient, disease, and treatment characteristics associated with PIRR.
Median follow-up was 86 months (range, 11-161 months). The 7-year PIRR-free rate was 71% (38 PIRRs in 35 patients). The 7-year rate of PI replacement was 17.1% (21), and removal was 13.3% (17). Reasons for PIRR included infection (15); implant extrusion, shift, leak, or rupture (4); patient request (1), or multifactorial (17). On univariate analysis, no factor was significantly associated with PIRR. Two patients experienced local recurrence in the chest wall, both after 7 years. The 7-year distant metastasis-free survival rate was 81% and overall survival 93%.
Favorable 7-year PIRR rates and clinical outcomes were achieved in a sizable cohort of patients treated with homogeneous sequencing, radiation, and reconstructive surgery and lengthy follow-up. Factors predictive for high risk of PIRR were not identifiable in this population.

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    • "The LD flap is a reliable flap that allows the mobilization of a large amount of muscle, subcutaneous fat, and skin. However, the LD flap is associated with donor-site seromas and hematomas,7,8 and reports have cited an overall complication rate of up to 30.4% and implant failure rate of 5.4%.8 Furthermore, by using the traditional method of LD flap interpolation, the entire muscle is sacrificed. "
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    Full-text · Article · May 2014
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    • "A study from a single institution on complications after 1170 expander/implant breast reconstruction found around 10e20% of patients experience implant complications irrespective the use of radiotherapy [11]. Ho et al., also reported similar outcomes [12]. One of the main challenges of immediate reconstruction after mastectomy in the pregnant patient is that the breast size and stiffness during puerperium is unpredictable. "
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