Sunday, October 10, 2004

Implant Reconstruction in Patients Who Receive Radiation for Breast Cancer

Matthew M. Hanasono, MD, Martin I. Newman, MD, Duncan B. Hughes, MD, and Jeffrey A. Ascherman, MD.

Purpose: To evaluate the outcome of implant breast reconstruction in patients who have received radiation prior to or following mastectomy for breast cancer.

Introduction: The use of implant breast reconstruction in patients who receive radiation therapy for breast cancer is controversial. Prior studies are limited by older prosthetic devices, reconstructive techniques, and radiation therapy protocols.

Methods and Materials: Retrospective review of patients undergoing tissue expansion and implant breast reconstruction by a single surgeon after mastectomy for breast cancer from 1996 to 2003.

Experience: 108 patients (127 breasts) underwent mastectomy and implant breast reconstruction. The average length of postoperative follow-up was 15.9 months. 31 patients (31 breasts) received either pre- or postmastectomy radiation therapy.

Results: Major complications and total complications (major and minor combined) were more frequent in breasts that received radiation than breasts that did not receive radiation (26% vs. 6% for major complications, p<0.01, and 42% vs. 17% for total complications, p<0.01, respectively). Breast symmetry and patient satisfaction were significantly lower in patients who received radiation compared to those who did not (p<0.001 and p<0.05, respectively). Diabetes and chemotherapy were independently associated with increased complications but neither association was statistically significant.

Conclusion: Breast reconstruction in patients who receive radiation therapy is associated with more frequent complications and decreased aesthetic results. However, the present results compare favorably to those reported in prior studies. Improved results in the present study may be attributable to the use of newer prostheses, staged breast reconstruction with initial tissue expansion, total muscular coverage of the implant, and modern radiation therapy protocols.

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