scholarly journals Breast Reconstruction and Radiation Therapy

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481879548 ◽  
Author(s):  
Johanna H. Yun ◽  
Roberto Diaz ◽  
Amber G. Orman
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Data Extraction ◽  
Tissue Expander ◽  
Abdominal Muscle ◽  
Optimal Timing ◽  
Autologous Reconstruction ◽  
Optimal Approach

Purpose: The optimal approach to the integration of postmastectomy reconstruction and radiation therapy is not well-established. This review will summarize current literature pertaining to the most common types of reconstruction in the setting of postmastectomy radiation therapy (PMRT). Data Sources: Literature from PubMed was reviewed from 2000 to 2016. Study Selection: Studies were selected with relevance to “postmastectomy breast reconstruction,” “breast reconstruction,” and “breast reconstructive methods and PMRT.” Surgical outcomes, patient satisfaction, and cost-effectiveness were examined. Data Extraction: Data from publications was extracted, summarized, and converted to a table. Results of Data Synthesis: Implant-based techniques are on the rise, in the setting of PMRT. Implant-based methods are more affordable in the short term and result in immediate breast-mound formation compared to autologous methods. When compared to implant-based reconstruction with PMRT, autologous reconstruction with PMRT results in better quality of life (QoL) and sensory recovery as well as fewer complications and failures. Among autologous flaps, deep inferior epigastric perforator flaps are considered superior to transverse rectus abdominal muscle (TRAM) pedicled flaps and may be more suitable for PMRT. Latissimus dorsi and muscle-sparing free TRAM flaps are also viable options. In delayed autologous, which may be advantageous for high-risk patients, the optimal timing to delay surgery after radiation therapy is unknown. Reconstruction with a 2-stage tissue expander-implant technique offers good to excellent cosmetic outcomes in the setting of PMRT, although there may be complications in this 2-stage process. Conclusion: Surgical, cosmetic, quality of life, and life expectancy must be taken into account when selecting the way to integrate breast reconstruction and PMRT.

Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

2019 ◽  
Vol 35 (06) ◽  
pp. 445-451 ◽  
Author(s):  
George N. Kamel ◽  
David Nash ◽  
Joshua Jacobson ◽  
Robin Berk ◽  
Karan Mehta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Breast Reconstruction ◽  
Medical Center ◽  
Tissue Expander ◽  
Well Being ◽  
Minority Population ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Patient Reported

Background Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction. Methods A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed. Results A total of 79 patients met inclusion criteria: 34.2% (n = 27) in the delayed and 65.8% (n = 52) in the DI group. 77.2% (n = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [n = 24] vs. 7.4% [n = 2]; p = 0.0005) and to have major mastectomy flap necrosis (22.4% [n = 17] vs. 0.0% [n = 0]; p = 0.002). Premature tissue expander removal occurred in 17.3% (n = 9) of patients in the DI group. BREAST-Q response rates were 44.4% (n = 12) in the delayed group and 57.7% (n = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome. Conclusion Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.

scholarly journals Comparison between Immediate and Delayed Prosthetic Breast Reconstruction Following Mastectomy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
B A Wassef ◽  
W H Hassan ◽  
R M Ahmed ◽  
E S Shebl
Keyword(s):  
Quality Of Life ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
University Hospital ◽  
University Hospitals ◽  
Immediate Reconstruction ◽  
Safe Alternative ◽  
Group A

Abstract Purpose to compare the outcomes of Immediate versus Delayed prosthetic breast reconstruction. Together with highlighting the importance of immediate reconstruction when it is feasible. Materials and methods This was a prospective study that was held at ain shams university hospitals and Helwan university hospital. The study included 20 patients who were planned to undergo a mastectomy either unilateral or bilateral, patients were divided equally in to 2 groups, (Group A) had an immediate breast reconstruction using mammary implants, while (Group B) had a delayed breast reconstruction using tissue expander then replacing it after a few months with a mammary implant, and the post operative complications were compared against each other. Results Although the number of complications were more in (Group A), but statistically it was found that the rate of complications after immediate reconstruction was non significant from after delayed reconstruction. Conclusion both immediate and delayed mastectomy reconstruction provide substantial safety and quality of life benefits for women choosing these procedures. Furthermore, patients who postpone reconstruction after mastectomy due to personal preference or by medical necessity can be reassured that this approach is a safe alternative to immediate reconstruction and can provide equivalent quality of life and body image benefits.

scholarly journals Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 226 ◽  
Author(s):  
Jeremie D. Oliver ◽  
Daniel Boczar ◽  
Maria T. Huayllani ◽  
David J. Restrepo ◽  
Andrea Sisti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Optimal Timing ◽  
Implant Placement ◽  
Postmastectomy Radiation ◽  
Postmastectomy Radiation Therapy ◽  
The Impact ◽  
Implant Breast Reconstruction

Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection.

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

2021 ◽  
Author(s):  
Adrienne N. Christopher ◽  
Martin P. Morris ◽  
Robyn B. Broach ◽  
Joseph M. Serletti
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Locally Advanced Breast Cancer ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Tissue Expander ◽  
Optimal Timing ◽  
Postmastectomy Radiation ◽  
Postmastectomy Radiation Therapy

Abstract Background Postmastectomy radiation therapy (PMRT) is an important component in the treatment of locally advanced breast cancer. Optimal timing of therapy in relation to autologous breast reconstruction (ABR) remains clinically debated. Herein, we comparatively analyze short- and long-term outcomes between immediate ABR (I-ABR) and delayed-immediate ABR (DI-ABR) in the setting of PMRT. Methods Adult patients undergoing ABR with PMRT were separated into cohorts based on reconstructive timeline: I-ABR or DI-ABR. The groups were propensity matched 1:1 by age, body mass index, and comorbidities. Surgical site events and long-term clinical outcomes (readmissions, reoperations, and revision procedures) were collected. Univariate analyses were completed using Pearson's chi-squared tests and Fisher's exact tests, and statistical significance was set at p < 0.05. Results One hundred and thirty-two flaps (66 in each cohort) were identified for inclusion. Patients with I-ABR were more likely to experience fat necrosis (p = 0.034) and skin necrosis (p < 0.001), require additional office visits (p < 0.001) and outpatient surgeries (p = 0.015) to manage complications, and undergo revision surgery after reconstruction (p < 0.001). DI-ABR patients, however, had a 42.4% incidence of complications following tissue expander placement prior to reconstruction, with 16.7% of patients requiring reoperation during this time. Only one patient (I-ABR) experienced flap loss due to a vascular complication. Conclusion The complications encountered in both of these groups were not prohibitive to offering either treatment. Patients should be made aware of the specific and unique risks of these reconstruction timelines and involved throughout the entire decision-making process. Plastic surgeons should continue to strive to elucidate innovative approaches that facilitate enhanced quality of life without compromising oncologic therapy.

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