Assessing Long Term Complications in Patients Undergoing Immediate Postmastectomy Breast Reconstruction and Adjuvant Radiation

Publication date: Available online 30 October 2016
Source:Practical Radiation Oncology
Author(s): R. Sacotte, N. Fine, J.Y. Kim, M. Alghoul, K. Bethke, N. Hansen, S.A. Khan, S. Kulkarni, J. Strauss, J. Hayes, E.D. Donnelly
PurposeTo report the long-term rate and timing of complications associated with postmastectomy radiation therapy (PMRT) following immediate breast reconstruction in a large patient population.Materials/MethodsWe identified and reviewed the charts of all patients with stage I-IIIC breast cancer who underwent mastectomy with immediate reconstruction followed by subsequent radiation therapy between November 1997 and May 2010. We aimed to assess the rate of major complications, defined as events requiring a separate and distinct procedure. Statistical analysis between variables was evaluated using Fisher's exact test and Pearson's Chi-Squared test.ResultsIn total, 134 patients met inclusion criteria having adequate long-term follow-up and documentation. The median follow-up for all patients was 77.4months (range 6–185months). The overall major complication rate was found to be 44%. Nine patients (6.7%) experienced complications for which a secondary procedure could not be performed to retain a reconstructed breast. The average time between initiation of PMRT and the first major complication was 13.5months, with 68.3% of first major complications occurring within 1year of PMRT initiation and 81.7% within 2years. The difference in incidence of major complications for patients undergoing immediate tissue expander/implant (TE/I) reconstruction followed by PMRT was not statistically different when compared to patients with immediate autologous tissue reconstruction (ATR) followed by PMRT (47.3% vs 30.4%, p=0.168).ConclusionThe risk of first major complications and reconstruction loss in patients undergoing PMRT on immediately reconstructed breasts is greatest within 1year of beginning radiation therapy and decreases significantly with time. Immediate autologous tissue reconstruction followed by PMRT can be performed with reasonable complication rates.



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