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Expander-to-Implant Exchange Timing After Postmastectomy Radiation Therapy: A Propensity-Matched Multi-Institutional Study
Timothy C. Olsen
*1, Ariel Gabay
2, Aamirah Mccutchen
1, Robyn B. Broach
1, Evan Matros
2, Babak J. Mehrara
2, Robert J. Allen
2, Joseph Serletti
1, Jonas Nelson
2, Said Azoury
11Division of Plastic Surgery, University of Pennsylvania, Philadelphia , PA; 2Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
Background: The optimal interval between postmastectomy radiation therapy (PMRT) and expander-to-implant exchange in dual-stage implant-based breast reconstruction (IBBR) remains controversial, despite exchange timing serving as one of the few modifiable management points for PMRT patients. This study evaluates whether exchange within 6 months following PMRT is associated with higher post-implant morbidity.
Methods: A multi-institutional, retrospective, breast-level analysis included immediate IBBR followed by PMRT and subsequent implant exchange (2014-2025). Exchange was classified as early (≤6 months) or delayed (>6 months). Three-to-one nearest-neighbor propensity matching balanced baseline differences, and adjusted patient-clustered logistic regression assessed 90- and 365-day post-implant complications.
Results: Of 1,842 breasts, 349 underwent early and 1,493 delayed exchange; 808 breasts remained after matching (345 early, 463 delayed). At 90 days, early exchange was associated with higher rates of any complication (6.7% vs 1.1%), infection (4.4% vs 1.1%), return to the OR (14.3% vs 0%), and implant exposure (1.7% vs 0%), with higher adjusted odds of any complication (OR 8.27, 95% CI 3.02-22.67), infection (4.86, 1.69-13.94), reoperation (40.67, 13.32-124.18), and implant exposure (21.61, 9.05-51.59). At 365 days, early exchange remained associated with any complication (10.1% vs 4.5%; OR 2.25, 1.05-4.83) and reoperation (21.4% vs 6.4%; OR 8.13, 2.22-29.76).
Conclusions: Expander-to-implant exchange within 6 months after PMRT was associated with greater short-term morbidity and persistent 1-year reoperation risk. When clinically permissible, second-stage expander exchange to permanent prosthesis should wait until after 6 months following PMRT to reduce the risk of complications.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
