Abstract 70: The Impact of Post-Mastectomy Radiation Therapy on Permanent Implants in Direct-to-Implant Breast Reconstruction versus Tissue Expanders in Two-Stage Breast Reconstruction.
Year: 2018
Type: conference-abstract
Abstract: PURPOSE: Post-mastectomy radiotherapy (PMRT) plays a key role in influencing the reconstructive outcome of implant-based breast reconstruction. While some studies have reviewed the effects of PMRT on a tissue expander (TE) in two-stage breast reconstruction, few studies have assessed the impact of PMRT after direct-to-implant reconstructions (DTI) breast reconstruction. This study evaluates complications and reconstructive outcomes of PMRT in DTI compared to two-stage breast reconstruction. METHODS: Single-institution retrospective review of immediate implant-based breast reconstruction patients that received post-mastectomy radiotherapy from 2006–2014 with a minimum of a 2-year follow-up were reviewed. All patients who received preoperative radiotherapy were excluded. RESULTS: Out of the 1671 patients, 265 patients were identified to have received post-mastectomy radiation. Of the 265, 149 received DTI and 116 had two-stage tissue expander to implant (TE-I) reconstruction. The overall mean age was 46.5 and BMI 26.9. There were no significant differences in demographics except more smokers in the TE group (7.7% vs. 1.3%, p=0.009). The DTI group had a significantly higher use of Alloderm compared to the TE group (72.5% vs. 41.4%, p<0.001). Patients who received PMRT with a tissue expander in place had more complications (32.7% vs. 10.7%, p<0.001), skin-necrosis (10.3% vs 4.0%, p<0.001), wound breakdown (9.5% vs. 2.0%, p=0.011) and infections (16.3% vs. 4.03%, p<0.001) leading to a higher rate of explantation (16.3% vs. 3.3%, p<0.001). When comparing the reconstructive outcomes, the TE group had a higher failure rate (20.6% vs. 10.7%, p=0.025). However we found the revision for capsular contracture rates to be similar between the two cohorts (11.4% vs. 10.3%, p=0.783) as well as revision rates for contour asymmetry, size mismatch and malposition. Subgroup analysis of DTI with ADM vs. TE-I with ADM showed similar complication findings; however, the DTI group had significantly higher revision rates (21.1% vs. 7.4%, p=0.029). In our multivariate regression analysis, radiation to the TE had a higher risk of reconstruction failure than radiation after DTI reconstruction (OR 2.004, 95% CI: 0.987–4.067, p=0.05). CONCLUSION: The optimal timing of post-mastectomy radiotherapy on implant-based breast reconstruction remains to be determined. Our study showed that PMRT after direct-to-implant breast reconstruction had a lower reconstructive failure rate compared to two-stage reconstruction. A.M. Lin: None. J.M. Christensen: None. E.C. Liao: None. C.L. Cetrulo: None. A.G. Taghian: None. J.M. Winograd: None. B.L. Smith: None. W.G. Austen: None. A.S. Colwell:; Allergan.; Lifecell.
Institutions: Massachusetts General Hospital, Quinnipiac University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W2799511101