Immediate Reconstruction of the Radiated Breast: Recent Trends Contrary to Traditional Standards.

Abstract

Immediate, implant-only breast reconstruction is traditionally discouraged in patients who receive radiation. It is not clear whether this widely recognized mantra of breast reconstruction is observed in practice. The purpose of this study was to evaluate immediate reconstruction trends and practices in patients who have undergone mastectomy and radiation therapy. Female patients with unilateral breast cancer who required radiation in addition to mastectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Patients who underwent immediate reconstruction were identified and analyzed. Univariate and logistic regression analyses were performed to study the relationship between reconstructive method and patient demographic and oncologic characteristics. A total of 5,481 female patients who underwent radiation and breast reconstruction were included for analysis. Postmastectomy radiation therapy was performed in 98.3% of the patients. The immediate breast reconstruction rate among patients requiring radiation increased from 13.6 to 25.1%. The percentage of reconstructed patients who had implant-only reconstruction increased from 27 to 52% (p<0.001) with a decrease in tissue-only reconstruction from 56 to 32% (p<0.001). In regression analysis, the odds of implant reconstruction over autologous reconstruction increased each year by an odds ratio of 1.13 (95% CI 1.10-1.15). The frequency of immediate reconstruction continues to increase in the setting of postmastectomy radiation therapy, with immediate implant-based reconstruction representing the most commonly utilized method, contrary to traditional recommendations. These findings likely reflect changing attitudes towards implant reconstruction in the setting of planned postmastectomy radiation.