Radiation Injury and Its Impact On the Outcomes of Implant-Based Breast Reconstruction: An Outcome Study

Background:

More women with breast cancer who either have already had radiation therapy or will be getting radiation therapy as part of their treatment protocol are now seeking implant-based breast reconstruction. The literature on the success of this type of reconstruction in the setting of radiation injury is mixed.

Methods:

A total of 1989 breast reconstructions performed between January 1999 and September 2011 were studied.  The 1989 breast reconstructions were obtained from 1286 procedures, 583 unilateral and 703 bilateral, among 1214 women. The cohort was divided into 3; patients who received no radiation (group 1; n=1009), pre-operative (group 2; n=118) or post-operative (group 3; n=159) radiation.  Age, follow-up time, history (diabetes, smoking, and chemotherapy), body mass index, and expander volume were recorded. Logistical regression analysis was performed for major reoperative complications following the reconstruction.

Results:

The odds ratios for the association of the indicator for any radiation with any complication, rupture, infection, seroma/hematoma, wound healing problem, and TE exposed were 1.38 (0.98 – 1.93; p=0.066), 1.53 (95% CI 0.89 – 2.61; p=0.12), 1.17 (95% CI 0.63 – 2.16; p=0.62), 1.13 (95% CI 0.58 – 2.18; p=0.72), 1.29 (95% CI 0.69 – 2.41; p=0.42), and 1.83 (95% CI 0.55 – 6.13; p=0.33), respectively.

The difference between radiated vs non-radiated patients was statistically significant interims of “any complication” (meaning any one of the 5 complications listed) 56(20%) vs 157(16%); p=0.045.

The odds ratios for "any complication" for pre XRT vs non-pre XRT: 1.32 (95% CI 0.82 - 2.13; p=0.25) Post XRT vs non-post XRT: 1.32 (95% CI 0.87 - 2.00; p=0.20). The most common complication in both radiation groups was infection, wound dehiscence and seroma / hematoma formation was also seen more commonly in patients with pre-operative radiation therapy.

Conclusions:

Perioperative radiation therapy (including preoperative or post-operative radiation therapy) for the treatment of breast cancer increased complications and reconstruction failures.  Most of the complications were related to wound infection.