Outcomes Following Breast Reconstruction in Patients with Prior Mantle Radiation for Treatment of Hodgkin's Lymphoma
Brian B. Freniere, MD1, Gretchen Guldbrandsen, BA2, Laura S. Dominici, MD2, Emily Lafleur, PA-C3, Daniel Sturgeon, MS2, Yoon S. Chun, MD3.
1Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA, 3Harvard Medical School, Brigham and Women's Hospital/Faulkner Hospital, Boston, MA, USA.
BACKGROUND: External beam radiation in the mantle field has been a mainstay of therapy for Hodgkin's lymphoma for several decades. While the incidence of breast cancer in patients treated with mantle radiation is known to be elevated and mastectomy is often indicated, little has been reported regarding the outcomes of breast reconstruction in this high-risk group. The current study presents the largest series of immediate breast reconstruction in this population and aims to evaluate reconstruction outcomes and examine differences between implant-based and autologous reconstructions.
METHODS: A retrospective review of records from a 10-year period at two institutions was performed. Patients with prior mantle radiation for Hodgkin's lymphoma therapy who subsequently underwent mastectomy with immediate reconstruction were identified and included for analysis. Patient demographics, clinical characteristics, and outcomes including complications and operative revisions were collected. Univariate and multivariate analyses were performed to examine differences between implant-based and autologous reconstructions.
RESULTS: A total of 99 breast reconstructions were performed in 53 patients. 81 reconstructions were implant-based and 18 were autologous. Patients with autologous reconstructions were younger than implant-based reconstructions (42 ± 6.5 vs 47 ± 8.8 years, p<0.05). Both groups had long-term follow-up, however, the mean duration of follow-up was longer in the autologous group compared to implant-based group (8.3 vs 5 years, p<0.05). Otherwise, the groups were similar with respect to BMI, medical comorbidities, oncologic diagnosis, and therapy. The time between mantle radiation and reconstruction was similar for implant-based and autologous groups (23.4 ± 9 vs 21.3 ± 6.1 years, p=0.6). The overall complication rate of breast reconstruction was not statistically different between the implant-based and autologous groups (35% vs 16%, p=0.16). Three implant-based reconstructions (3.7%) failed requiring explantation, and there were no complete flap losses in the autologous group. An associated 5-fold higher rate of unplanned revisions was observed with the autologous reconstruction group compared to the implant-based reconstruction group (OR: 5.29, 95% CI: 1.24-22.51, p=0.025).
CONCLUSIONS: Immediate breast reconstruction in patients with prior mantle radiation can be achieved safely with an acceptable complication profile utilizing both implant-based and autologous techniques. Autologous breast reconstruction is associated with a higher rate of revisions compared to implant-based breast reconstruction.
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