TY - JOUR

T1 - Delayed two-stage breast reconstruction

T2 - The impact of radiotherapy

AU - Hoejvig, Jens H

AU - Pedersen, Nicolas J

AU - Gramkow, Christina S

AU - Bredgaard, Rikke

AU - Kroman, Niels

AU - Bonde, Christian T

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Despite a trend towards immediate breast reconstruction in recent years, delayed breast reconstruction using a tissue expander remains a common procedure. Radiotherapy after mastectomy but before reconstruction is a risk factor, although studies examining the effect of this are limited. The aim of this retrospective cohort study is to evaluate the impact of pre-reconstructive radiotherapy (PRT) in patients undergoing breast reconstruction using an expander/implant.MATERIALS AND METHODS: Two hundred twenty-three consecutive patients underwent unilateral mastectomy followed by expander-based reconstruction over a 10-year period (2004-2013). Fifty patients (22%) received radiotherapy before reconstruction (PRT group), and 173 patients (78%) did not (non-PRT group). Descriptive patient data as well as data regarding the operations, hospitalisation and complications were collected. Statistical analyses such as logistic regression, Fisher exact test and multivariate analysis were performed using R-statistics.RESULTS: PRT was a significant predictor of loss of reconstruction, and when adjusted for smoking and body mass index (BMI), it showed an odds ratio (OR) of 17.8 [95% confidence interval (CI): 5.7-70.6; p<0.01] for loss of reconstruction, with 15 (30%) in the PRT group and 7 (4%) in the non-PRT group. We found no difference in short-term reoperations or infections at either stage of reconstruction.CONCLUSION: In patients undergoing delayed breast reconstruction using an expander/implant, radiotherapy is a significant risk factor for loss of reconstruction. It should be considered a relative contraindication for this reconstructive modality, and careful selection and advisement of the patient about the risks of complications and potential need for additional corrective surgery or later autologous breast reconstruction should be discussed.

AB - BACKGROUND: Despite a trend towards immediate breast reconstruction in recent years, delayed breast reconstruction using a tissue expander remains a common procedure. Radiotherapy after mastectomy but before reconstruction is a risk factor, although studies examining the effect of this are limited. The aim of this retrospective cohort study is to evaluate the impact of pre-reconstructive radiotherapy (PRT) in patients undergoing breast reconstruction using an expander/implant.MATERIALS AND METHODS: Two hundred twenty-three consecutive patients underwent unilateral mastectomy followed by expander-based reconstruction over a 10-year period (2004-2013). Fifty patients (22%) received radiotherapy before reconstruction (PRT group), and 173 patients (78%) did not (non-PRT group). Descriptive patient data as well as data regarding the operations, hospitalisation and complications were collected. Statistical analyses such as logistic regression, Fisher exact test and multivariate analysis were performed using R-statistics.RESULTS: PRT was a significant predictor of loss of reconstruction, and when adjusted for smoking and body mass index (BMI), it showed an odds ratio (OR) of 17.8 [95% confidence interval (CI): 5.7-70.6; p<0.01] for loss of reconstruction, with 15 (30%) in the PRT group and 7 (4%) in the non-PRT group. We found no difference in short-term reoperations or infections at either stage of reconstruction.CONCLUSION: In patients undergoing delayed breast reconstruction using an expander/implant, radiotherapy is a significant risk factor for loss of reconstruction. It should be considered a relative contraindication for this reconstructive modality, and careful selection and advisement of the patient about the risks of complications and potential need for additional corrective surgery or later autologous breast reconstruction should be discussed.

KW - Adult

KW - Breast Neoplasms/radiotherapy

KW - Female

KW - Hospitalization

KW - Humans

KW - Mammaplasty/adverse effects

KW - Mastectomy

KW - Middle Aged

KW - Postoperative Complications/epidemiology

KW - Radiotherapy, Adjuvant/adverse effects

KW - Retrospective Studies

KW - Time-to-Treatment

KW - Tissue Expansion Devices

KW - Treatment Outcome

U2 - 10.1016/j.bjps.2019.06.003

DO - 10.1016/j.bjps.2019.06.003

M3 - Journal article

C2 - 31350217

VL - 72

SP - 1763

EP - 1768

JO - Journal of Plastic, Reconstructive & Aesthetic Surgery (Print Edition)

JF - Journal of Plastic, Reconstructive & Aesthetic Surgery (Print Edition)

SN - 1748-6815

IS - 11

ER -