Immediate two-stage prosthetic breast reconstruction failure: radiation is not the only culprit

Thomas C. Lam, Robert Borotkanics, Frank Hsieh, James Salinas, John Boyages

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Immediate prosthetic breast reconstruction produces a satisfactory aesthetic result with high levels of patient satisfaction. However, with the broader indication for postmastectomy adjuvant radiation therapy, many patients are advised against immediate breast reconstruction because of concerns of implant loss and infection, particularly as most patients also require chemotherapy. This retrospective cohort study examines outcomes for patients who underwent immediate two-stage prosthetic breast reconstruction after mastectomy with or without adjuvant chemotherapy or radiotherapy. Methods: Between 1998 and 2010, 452 patients undergoing immediate two-stage prosthetic breast reconstruction involving a total of 562 breasts were included in this study. Stage 1 was defined as insertion of the temporary expander, and stage 2 was defined as insertion of the final silicone implant. Postoperative adjuvant radiotherapy was recommended with a tissue expander in situ for 114 patients. Complications, including loss of prosthesis, seroma, and infection, were recorded and analyzed. Cosmetic result was assessed using a four-point scale. Results: Postoperative prosthesis loss was 2.7 percent, 5.3 percent for patients undergoing adjuvant chemotherapy and increasing to 11.3 percent for patients receiving chemotherapy plus radiotherapy. Chemotherapy and radiotherapy independently were the main, statistically significant risk factors for expander or implant loss [incidence rate ratio, 13.85 (p = 0.012) and 2.23 (p = 0.027), respectively]. Prosthesis loss for patients undergoing combination chemotherapy plus radiotherapy was also significant [incidence rate ratio, 4.791 (p < 0.001)]. Conclusions: These findings serve to better inform patients on risk in weighing treatment options. Postmastectomy radiation therapy doubles the risk of prosthesis loss over and above adjuvant chemotherapy but is an acceptable option following immediate two-stage prosthetic breast reconstruction in a multidisciplinary setting. Clinical question/Level of evidence: Therapeutic, III.

LanguageEnglish
Pages1315-1324
Number of pages10
JournalPlastic and reconstructive surgery
Volume141
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

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Mammaplasty
Radiation
Radiotherapy
Prostheses and Implants
Adjuvant Chemotherapy
Adjuvant Radiotherapy
Drug Therapy
Tissue Expansion Devices
Seroma
Mastectomy
Incidence
Silicones
Infection
Combination Drug Therapy
Patient Satisfaction
Esthetics
Cosmetics
Breast
Cohort Studies
Retrospective Studies

Keywords

  • TEMPORARY TISSUE EXPANDER
  • CHEST-WALL RADIOTHERAPY
  • POPULATION-BASED COHORT
  • TERM-FOLLOW-UP
  • PATIENT SATISFACTION
  • ADJUVANT RADIOTHERAPY
  • PREMENOPAUSAL WOMEN
  • CANCER PATIENTS
  • METALLIC PORTS
  • POSTMASTECTOMY

Cite this

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title = "Immediate two-stage prosthetic breast reconstruction failure: radiation is not the only culprit",
abstract = "Background: Immediate prosthetic breast reconstruction produces a satisfactory aesthetic result with high levels of patient satisfaction. However, with the broader indication for postmastectomy adjuvant radiation therapy, many patients are advised against immediate breast reconstruction because of concerns of implant loss and infection, particularly as most patients also require chemotherapy. This retrospective cohort study examines outcomes for patients who underwent immediate two-stage prosthetic breast reconstruction after mastectomy with or without adjuvant chemotherapy or radiotherapy. Methods: Between 1998 and 2010, 452 patients undergoing immediate two-stage prosthetic breast reconstruction involving a total of 562 breasts were included in this study. Stage 1 was defined as insertion of the temporary expander, and stage 2 was defined as insertion of the final silicone implant. Postoperative adjuvant radiotherapy was recommended with a tissue expander in situ for 114 patients. Complications, including loss of prosthesis, seroma, and infection, were recorded and analyzed. Cosmetic result was assessed using a four-point scale. Results: Postoperative prosthesis loss was 2.7 percent, 5.3 percent for patients undergoing adjuvant chemotherapy and increasing to 11.3 percent for patients receiving chemotherapy plus radiotherapy. Chemotherapy and radiotherapy independently were the main, statistically significant risk factors for expander or implant loss [incidence rate ratio, 13.85 (p = 0.012) and 2.23 (p = 0.027), respectively]. Prosthesis loss for patients undergoing combination chemotherapy plus radiotherapy was also significant [incidence rate ratio, 4.791 (p < 0.001)]. Conclusions: These findings serve to better inform patients on risk in weighing treatment options. Postmastectomy radiation therapy doubles the risk of prosthesis loss over and above adjuvant chemotherapy but is an acceptable option following immediate two-stage prosthetic breast reconstruction in a multidisciplinary setting. Clinical question/Level of evidence: Therapeutic, III.",
keywords = "TEMPORARY TISSUE EXPANDER, CHEST-WALL RADIOTHERAPY, POPULATION-BASED COHORT, TERM-FOLLOW-UP, PATIENT SATISFACTION, ADJUVANT RADIOTHERAPY, PREMENOPAUSAL WOMEN, CANCER PATIENTS, METALLIC PORTS, POSTMASTECTOMY",
author = "Lam, {Thomas C.} and Robert Borotkanics and Frank Hsieh and James Salinas and John Boyages",
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}

Immediate two-stage prosthetic breast reconstruction failure : radiation is not the only culprit. / Lam, Thomas C.; Borotkanics, Robert; Hsieh, Frank; Salinas, James; Boyages, John.

In: Plastic and reconstructive surgery, Vol. 141, No. 6, 01.06.2018, p. 1315-1324.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Immediate two-stage prosthetic breast reconstruction failure

T2 - Plastic and reconstructive surgery

AU - Lam, Thomas C.

AU - Borotkanics, Robert

AU - Hsieh, Frank

AU - Salinas, James

AU - Boyages, John

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Immediate prosthetic breast reconstruction produces a satisfactory aesthetic result with high levels of patient satisfaction. However, with the broader indication for postmastectomy adjuvant radiation therapy, many patients are advised against immediate breast reconstruction because of concerns of implant loss and infection, particularly as most patients also require chemotherapy. This retrospective cohort study examines outcomes for patients who underwent immediate two-stage prosthetic breast reconstruction after mastectomy with or without adjuvant chemotherapy or radiotherapy. Methods: Between 1998 and 2010, 452 patients undergoing immediate two-stage prosthetic breast reconstruction involving a total of 562 breasts were included in this study. Stage 1 was defined as insertion of the temporary expander, and stage 2 was defined as insertion of the final silicone implant. Postoperative adjuvant radiotherapy was recommended with a tissue expander in situ for 114 patients. Complications, including loss of prosthesis, seroma, and infection, were recorded and analyzed. Cosmetic result was assessed using a four-point scale. Results: Postoperative prosthesis loss was 2.7 percent, 5.3 percent for patients undergoing adjuvant chemotherapy and increasing to 11.3 percent for patients receiving chemotherapy plus radiotherapy. Chemotherapy and radiotherapy independently were the main, statistically significant risk factors for expander or implant loss [incidence rate ratio, 13.85 (p = 0.012) and 2.23 (p = 0.027), respectively]. Prosthesis loss for patients undergoing combination chemotherapy plus radiotherapy was also significant [incidence rate ratio, 4.791 (p < 0.001)]. Conclusions: These findings serve to better inform patients on risk in weighing treatment options. Postmastectomy radiation therapy doubles the risk of prosthesis loss over and above adjuvant chemotherapy but is an acceptable option following immediate two-stage prosthetic breast reconstruction in a multidisciplinary setting. Clinical question/Level of evidence: Therapeutic, III.

AB - Background: Immediate prosthetic breast reconstruction produces a satisfactory aesthetic result with high levels of patient satisfaction. However, with the broader indication for postmastectomy adjuvant radiation therapy, many patients are advised against immediate breast reconstruction because of concerns of implant loss and infection, particularly as most patients also require chemotherapy. This retrospective cohort study examines outcomes for patients who underwent immediate two-stage prosthetic breast reconstruction after mastectomy with or without adjuvant chemotherapy or radiotherapy. Methods: Between 1998 and 2010, 452 patients undergoing immediate two-stage prosthetic breast reconstruction involving a total of 562 breasts were included in this study. Stage 1 was defined as insertion of the temporary expander, and stage 2 was defined as insertion of the final silicone implant. Postoperative adjuvant radiotherapy was recommended with a tissue expander in situ for 114 patients. Complications, including loss of prosthesis, seroma, and infection, were recorded and analyzed. Cosmetic result was assessed using a four-point scale. Results: Postoperative prosthesis loss was 2.7 percent, 5.3 percent for patients undergoing adjuvant chemotherapy and increasing to 11.3 percent for patients receiving chemotherapy plus radiotherapy. Chemotherapy and radiotherapy independently were the main, statistically significant risk factors for expander or implant loss [incidence rate ratio, 13.85 (p = 0.012) and 2.23 (p = 0.027), respectively]. Prosthesis loss for patients undergoing combination chemotherapy plus radiotherapy was also significant [incidence rate ratio, 4.791 (p < 0.001)]. Conclusions: These findings serve to better inform patients on risk in weighing treatment options. Postmastectomy radiation therapy doubles the risk of prosthesis loss over and above adjuvant chemotherapy but is an acceptable option following immediate two-stage prosthetic breast reconstruction in a multidisciplinary setting. Clinical question/Level of evidence: Therapeutic, III.

KW - TEMPORARY TISSUE EXPANDER

KW - CHEST-WALL RADIOTHERAPY

KW - POPULATION-BASED COHORT

KW - TERM-FOLLOW-UP

KW - PATIENT SATISFACTION

KW - ADJUVANT RADIOTHERAPY

KW - PREMENOPAUSAL WOMEN

KW - CANCER PATIENTS

KW - METALLIC PORTS

KW - POSTMASTECTOMY

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U2 - 10.1097/PRS.0000000000004358

DO - 10.1097/PRS.0000000000004358

M3 - Article

VL - 141

SP - 1315

EP - 1324

JO - Plastic and reconstructive surgery

JF - Plastic and reconstructive surgery

SN - 0032-1052

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