Short-term outcomes of immediate breast reconstruction using an implant or tissue expander after mastectomy in breast cancer patients

Abstract Background Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%). Results In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications. Conclusions IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR. Trial registration Patients were selected and registered retrospectively, and medical records were evaluated.

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The impact of adjuvant radiotherapy on the outcome of immediate breast reconstruction after mastectomy in breast cancer patients

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov201810481-88 ◽

2019 ◽

Vol 10 (4) ◽

pp. 81-88

Author(s):

Nikolay Sergeevich Romanenkov ◽

Konstantin N. Movchan

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Cancer Patients ◽

Adjuvant Radiotherapy ◽

Tissue Expander ◽

Immediate Breast Reconstruction ◽

Silicone Implants ◽

Breast Cancer Patients ◽

Tissue Expanders ◽

The Impact

Background. Data allowing to estimate the impact of postoperative radiotherapy on the possibility of prosthetic breast reconstruction with silicone implants or tissue expanders are mainly presented in single-level retrospective cohort studies. Material and methods. We searched for scientific papers in English published from January 1, 2000 to September 30, 2018 in the PubMed/MEDLINE database. The study parameters included demographic data, the method of breast reconstruction, information about adjuvant radiotherapy parameters, the incidence of postoperative complications. Results and discussion. Having studied the data about immediate prosthetic breast reconstruction with silicone implant or a tissue expander performed after mastectomy in 3,654 breast cancer patients. The complications after surgery were reported in 40% of all clinical observations. In 15% of cases, the specialists stopped the attempts to perform breast reconstruction. In general, the aesthetic results of immediate prosthetic breast reconstruction performed before postop radiotherapy are far from being perfect. Nevetheless, most patients are satisfied with them after the surgery. Conclusion. Adjuvant radiotherapy has a negative impact on the results of immediate prosthetic breast reconstruction after mastectomy. Despite this, the need for radiotherapy should not be regarded as an absolute contraindication for the immediate breast reconstruction with silicone implants and tissue expanders.

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