The Impact of Radiation Therapy, Lymph Node Dissection, and Hormonal Therapy on Outcomes of Tissue Expander-Implant Exchange in Prosthetic Breast Reconstruction

• Published in: Plastic and reconstructive surgery (1963) Vol. 137; no. 1; p. 1
• Main Authors: Wang, Frederick, Peled, Anne Warren, Chin, Robin, Fowble, Barbara, Alvarado, Michael, Ewing, Cheryl, Esserman, Laura, Foster, Robert, Sbitany, Hani
• Format: Journal Article
• Language: English
• Published: United States 01.01.2016
• Subjects: Adult; Antineoplastic Agents, Hormonal - adverse effects; Axilla; Breast Implants - adverse effects; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Neoplasms - therapy; Chemotherapy, Adjuvant - adverse effects; Confidence Intervals; Databases, Factual; Female; Follow-Up Studies; Graft Rejection; Humans; Lymph Node Excision - adverse effects; Lymph Nodes - pathology; Lymph Nodes - surgery; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy, Subcutaneous - methods; Middle Aged; Multivariate Analysis; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Radiotherapy, Adjuvant - adverse effects; Reoperation; Retrospective Studies; Risk Assessment; Sentinel Lymph Node Biopsy - adverse effects; Tissue Expansion - adverse effects; Tissue Expansion Devices - adverse effects; Treatment Outcome
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000001866

Total skin-sparing mastectomy, with preservation of the nipple-areola complex, must account for adjuvant medical and surgical treatments for cancer. The authors assessed risk factors for complications after second-stage tissue expander-implant exchange. The authors reviewed all institutional total skin-sparing mastectomy cases that had completed tissue expander-implant exchange with at least 3 months of follow-up. They developed multivariate generalized estimating equation models to obtain adjusted relative risks of radiation therapy, type of lymph node dissection, and hormonal therapy in relation to postoperative complications. The authors performed 776 cases in 489 patients, with a median follow-up of 26 months (interquartile range, 10 to 48 months). Radiation therapy was associated with increased wound breakdown risk [relative risk (RR), 3.3; 95 percent CI, 2.0 to 5.7]; infections requiring oral antibiotics (RR, 2.2; 95 percent CI, 1.31 to 3.6), intravenous antibiotics (RR, 6.4; 95 percent CI, 3.9 to 10.7), or procedures (RR, 8.9; 95 percent CI, 4.5 to 17.5); implant exposure (RR, 3.9; 95 percent CI, 1.86 to 8.3); and implant loss (RR, 4.2; 95 percent CI, 2.4 to 7.4). Axillary lymph node dissection was associated with an increased risk of implant loss (RR, 2.0; 95 percent CI, 1.11 to 3.7) relative to sentinel lymph node biopsy. Axillary lymph node dissection increases the risk of implant loss compared with sentinel lymph node biopsy, independent of radiation therapy. Patients who require axillary lymph node dissection may be encouraged to undergo breast conservation or autologous reconstruction when possible. Therapeutic, III.