Impact of Radiation Timing on Complications in Pre-pectoral Alloplastic Breast Reconstruction: A Single Institutional Retrospective Cohort Study
Anshumi Desai*3, Emily Finkelstein1, Meaghan Clark2, Samantha A. McLaughlin2, Dylan Treger2, Devinder Singh1, Zubin Panthaki1, John Oeltjan1, Sara Danker1, Juan R. Mella-Catinchi1, Wrood Kassira1
1Department of Plastic Surgery, University Of Miami, Miami, FL; 2University Of Miami, Miami, FL; 3Department of Surgery, University Of Miami, Miami, FL
Complications are concerning following radiation therapy (RT) in patients with alloplastic breast reconstruction. The impact of RT on reconstructive outcomes has been less studied for reconstruction in the pre-pectoral plane. This study aims to evaluate the prevalence of complications in these patients with RT, with respect to the timing.
We analyzed 378 patients that underwent mastectomy with pre-pectoral alloplastic reconstruction, either Direct to implant (DTI), tissue expanders (TE), or delayed reconstruction. Patients were separated as those who received RT (n=131) and those without RT (n=247). The RT cohort was further subdivided into 3 sub-groups: DTI, TE, and delayed reconstruction. Incidence of different complications was assessed. Significance was p<0.05.
The non-RT cohort had lower complication rates compared to the RT cohort (Table). The relative risk (RR) of secondary surgeries (1.522) significantly increased in the RT cohort. The Post Mastectomy RT group had significantly more complications than patients without RT and those with prior history of radiation but no adjuvant radiation. Complications significantly increased in patients receiving RT in the setting of delayed reconstruction compared to immediate reconstruction. When the 3 sub-groups were analyzed separately all three had significantly higher complications as compared to the non-RT cohort. Major infection, secondary surgeries, and implant failure had significantly higher RR in the TE cohort. (RR=2.6, 2.6, and 2.1 respectively).
Patients undergoing pre-pectoral alloplastic breast reconstruction with RT had more complications. Risk of secondary surgeries was significantly elevated with RT. Delayed reconstruction had more complications. Major infections, secondary surgeries, and implant failure demonstrated higher RR among the TE cohort. Complications occurring immediately after surgery, but before RT were not excluded. Larger cohorts, extended follow-up, and timing of complications should be studied to understand individual complication rates.
Individual Complication Rates in Radiation and Non-Radiation Cohorts
| COMPLICATIONS | NON RADIATION COHORT(n=247) | RADIATION COHORT (n=131) |
| Minor infections | 25(10.12%) | 17(13%) |
| Major infections | 36(14.5%) | 29(22.1%) |
| Hematoma | 21(8.5%) | 11(8.4%) |
| Seroma | 44(17.8%) | 24(18.3%) |
| Wound breakdown | 51(20.6%) | 38(29%) |
| Flap necrosis | 13(5.26%) | 14(10.6%) |
| Secondary surgery for any complications | 47(19%) | 28(29%) |
| Implant Failure | 41(6.5%) | 31(23.6%) |
The relative risk (RR) of secondary surgeries (1.522) was significantly increased in the radiation group (p<0.05, CI 1.0515 - 2.2101).
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