Does the Timing of Radiation Therapy During Tissue Expansion Affect Implant-Based Breast Reconstruction Outcomes?
Phoebe McAuliffe, Jocellie Marquez, Kanad Ghosh, Kaitlin Monroig, Hunter Rogoff, Reona Kimura, Amir Mahmoud, Christopher Medrano, Tara L Huston, Jazon Ganz, Alexander Dagum, Sami Khan, Duc Bui
Stony Brook University, Stony Brook, NY
Introduction: Postmastectomy radiation therapy (XRT) can affect successful tissue expander breast reconstruction (TEBR) outcomes. Examining the timing of XRT in relation to tissue expansion process may elucidate ways to optimize results. This study investigates the temporal sequence between tissue expansion and XRT during 2-stage TEBR in order to characterize complications and final results.
Methods: Two-stage TEBRs (2011-2018) at a single institution were retrospectively reviewed from a prospectively maintained database. Patients undergoing XRT after stage 1 (tissue expander placement) and before stage 2 (permanent implant placement) were identified and split into three groups. Group 1 underwent XRT after tissue expander (TE) placement but before any expansion was started. Group 2 had partial expansion before XRT and completion of expansion after XRT, and group 3 underwent XRT after expansion was completed. Patients with XRT before TE placement or primary autologous breast reconstruction were excluded. Demographics, comorbidities, outcomes, complications, unplanned readmissions, reconstruction failure, and autologous reconstruction after failure of implant reconstruction were captured.
Results: Of 674 TEBRs, 96 patients underwent radiation during the expansion process and were included. Group 1 (n=12), group 2 (n=18) and group 3 (n=66) comprised 12.5%, 18.8% and 68.8% of the cohort. There was no significant difference in demographics (p=0.317), comorbidities (p=0.568-0.807), pre/post-operative chemotherapy (p=0.238-0.363), ADM use (p=0.229) or bilateral reconstruction (p=0.88) between groups. There was no difference in rate of any complication (p=0.284), infection (p=0.285), seroma (p=0.565), wound dehiscence (p=0.363) or hematoma (p=0.249). Group 1 was statistically more likely to develop fat necrosis (33.3% vs. 0% vs. 3%, p<0.001) compared to groups 2 and 3, respectively. Overall 35.4% of patients experienced complications during initial hospitalization for the procedure or after discharge leading to unplanned readmission, however, when stratified by timing of postmastectomy XRT, there was no difference between groups (p=0.405). In the entire cohort 10.4% developed TE loss and 21.9% ultimately underwent later autologous reconstruction after completion of TEBR. There was no statistically significant difference regarding TE loss (16.7% vs. 0% vs. 12.1%, p=0.522) or the need for autologous reconstruction (41.7% vs. 22.2% vs. 18.2%, p=0.194) between the groups 1, 2 and 3.
Conclusion:: We found adjuvant XRT in TEBR is associated with a relatively high complication rate (35%), 10% TE loss and 22% conversion to autologous breast reconstruction. However, the timing of XRT during the tissue expansion process does not impact these outcomes. There may be a higher incidence of fat necrosis in patients that undergo XRT before tissue expansion.
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