Abstract P5-14-02: Immediate Breast Reconstruction: The Effect of Radiation

Abstract

Abstract Background: Prior history of breast irradiation or anticipated need for postmastectomy radiation have been considered relative contraindications for immediate breast reconstruction. We evaluated the surgical outcomes between three groups of patients: patients without radiation exposure, those with radiation prior to immediate reconstruction, and those with radiation following immediate reconstruction to determine the differences in risk of post-surgical complications among groups. Methods: All patients undergoing mastectomy and immediate reconstruction with either a tissue expander or implant between January 1, 2005 and June 30, 2009 were entered into an IRB-approved prospective database. Routine institutional protocol consisted of immediate reconstruction with tissue expander, expansion during the1-2 months following surgery, radiation if indicated, followed by implant exchange at 3-6 months after completion of radiation. All complications were collected and recorded within a week of the event, and all patients had a minimum follow-up period of 6 months after implant exchange to allow for sufficient monitoring of complications. Major complications included infection requiring IV antibiotics, unplanned return to surgery, and tissue expander/implant loss. Results: A total of 446 mastectomies were identified. Of these, 341 had no radiation history, 33 had prior ipsilateral breast radiation, and 72 had post-mastectomy radiation. Overall, there were 160 major complications (36%), including 50 (11%) expander/implant losses. Patient age, BMI, diabetes, and history of tobacco use were not associated with increased risk of major complications in this cohort. However, both prior and postoperative radiation was associated with higher risk of both major complications and implant loss. Conclusion: Immediate reconstruction with implant or tissue expander is associated with a 36% risk of major postoperative complications, with the greatest number seen in those patients with history of previous chest wall irradiation. However, most implants were salvaged even in the setting of complications, and the overall implant loss rate was only 8% in unirradiated patients and 22% in those patients with postoperative RT. Although radiation history is not a contraindication to immediate breast reconstruction, patients undergoing this procedure must be well informed of their substantial risk of postoperative complications. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-02.