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Unilateral Preoperative Chest Wall Irradiation in Bilateral Tissue Expander/Implant Breast Reconstruction with Acellular Dermal Matrix: Complications and Outcomes
Yeliz Cemal, MD, Katie Weichman, MD, Claudia R. Albornoz, MD, Colleen M. McCarthy, MD, Andrea Pusic, MD, MHS, FRCSC, Babak J. Mehrara, MD, Joseph J. Disa, MD, FACS.
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
BACKGROUND: Prior breast irradiation is known to increase the rate of post-operative complications including capsular contracture in tissue expander/implant (TE/I) reconstruction. Acellular dermal matrix (ADM) is currently a popular adjunct heralded to decrease capsular contracture; however, recent studies have suggested a possible increase in the rate of early, postoperative complications with its use. The purpose of this investigation was to evaluate the rate of complications, capsular contracture, and aesthetic outcomes in patients undergoing bilateral, TE/I reconstruction with ADM in the setting of prior unilateral irradiation.
METHODS: A case-control study was conducted on all patients undergoing bilateral, ADM-assisted, TE/I reconstruction with a history of previous unilateral irradiation at a single institution. Each patient included had one radiated breast and one control breast. The rate of complications including infection, mastectomy skin flap necrosis, hematoma, seroma and capsular contracture were compared between the irradiated and control breasts. Chi-squared, Fisher’s method, and the Students t-tests were used for statistical analysis.
RESULTS: Twenty-three patients met inclusion criteria and had an average follow-up of 19 months (range: 4-60 months). Mean BMI was 24 kg/m2 (range: 19-37.5 kg/m2). When comparing radiated breasts to control breasts, the perioperative infection rate was 21.7% (n=5) versus 4.3% (n=1) (p=0.18). Rates of mastectomy skin flap necrosis, hematoma, and seroma were also not significantly different between the groups. Explantation occurred in only 4.3% (n=1) of the radiated cohort versus 0% in the control cohort (p=1.00). Forty percent of patients had no difference in capsular contracture rates when comparing irradiated and non-irradiated breasts. Sixty percent of patients had a contracture in the irradiated breast that was one Baker grade greater than the non-irradiated breast. BMI >25 and smoking history were significant independent risk factors for early postoperative complications in univariate analysis (p=0.01).
CONCLUSIONS: Previous radiation does not appear to increase the risk of early post-operative complications associated with ADM use in TE/I breast reconstruction. ADM should be used cautiously however, in patients with a BMI >25 or a smoking history. Additionally, ADM does not appear to affect the degree of capsular contracture formation in the setting of prior irradiation.
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