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Successful Prosthetic Breast Reconstruction After Radiation Therapy
Successful Prosthetic Breast Reconstruction After Radiation Therapy Percec I, Bucky LP (Univ of Pennsylvania, PA) Ann Plast Surg 60:527-531, 2008
Radiation has been considered a relative contraindication to prosthetic breast reconstruction. While this dogma has been challenged by recent reports, the data on radiation and immediate prosthetic reconstruction remain contradictory. We performed a controlled retrospective review of one surgeon’s 7-year experience with 21 irradiated patients who underwent tissue expander/implant breast reconstruction. When compared with nonirradiated patients, irradiated patients experienced a higher rate of seroma formation, infection, delayed healing, implant exposure, and systemic complications. The rate of capsular contracture, while significantly higher in the irradiated group, was comprised mostly of mild to moderate capsules. Hematoma formation, implant rupture, and operative revision rates were similar between the 2 groups and complication rates among irradiated patients remained overall low. This study supports prosthetic reconstruction as a reasonable option for many radiation patients. Although irradiated patients remain at higher risk for complications, overall complication rates are low and rates of successful reconstruction are high.
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The increasing use of radiation therapy for breast cancer has posed a challenging problem for breast reconstruction. The negative effects of radiation on implant-based breast reconstruction have been well documented, with complications such as infection, extrusion, capsular contracture, and failed reconstruction reported in 20% to 70% of cases.1-3 In this article, based on a single surgeon’s experience with 21 patients who underwent breast irradiation and tissue expander/implant breast reconstruction, the authors reported that compared with patients who did not undergo radiation therapy, those who did undergo this therapy experienced a higher rate of seroma formation (5%), infection (15%), delayed healing (5%), implant exposure (10%), and systemic complications. However, the authors concluded that the overall complication rate (7%) was low and that the rate of successful reconstruction was high. I am somewhat confused by this conclusion and by how the overall complication rate was calculated. The authors also failed to mention how many of these patients lost their expanders/implants as a result of infection, exposure, or severe capsular contracture and how many patients’ adjuvant therapy was delayed as a result of these complications. Because breast reconstruction is an elective procedure and its goal is to improve the patient’s quality of life, optimal reconstructive methods should have minimal complications.
Breast Diseases: A Year BookÒ Quarterly Vol 19 No 4 2009
Particularly when immediate breast reconstruction is performed, the reconstructive method needs to be safe and reliable with minimal complications so that adjuvant therapy, if needed, is not delayed. Other studies have advocated the use of implant-based breast reconstruction in patients who undergo radiation therapy and have suggested that prosthetic reconstruction is a reasonable option for many of these patients; however, this study does not seem to support this conclusion.2,3 D. W. Chang, MD
References 1. Spear S, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930-942. 2. Ascherman JA, Hanasono MM, Newman MI, Hughes DB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconst Surg. 2006; 117:359-365. 3. Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results and satisfaction among 156 patients. Plast Reconstr Surg. 2004;113:877-881.
Radiation has been considered a relative contraindication to prosthetic breast reconstruction. While this dogma has been challenged by recent reports, the data on radiation and immediate prosthetic reconstruction remain contradictory. We performed a controlled retrospective review of one surgeon’s 7-year experience with 21 irradiated patients who underwent tissue expander/implant breast reconstruction. When compared with nonirradiated patients, irradiated patients experienced a higher rate of seroma formation, infection, delayed healing, implant exposure, and systemic complications. The rate of capsular contracture, while significantly higher in the irradiated group, was comprised mostly of mild to moderate capsules. Hematoma formation, implant rupture, and operative revision rates were similar between the 2 groups and complication rates among irradiated patients remained overall low. This study supports prosthetic reconstruction as a reasonable option for many radiation patients. Although irradiated patients remain at higher risk for complications, overall complication rates are low and rates of successful reconstruction are high.
362
The increasing use of radiation therapy for breast cancer has posed a challenging problem for breast reconstruction. The negative effects of radiation on implant-based breast reconstruction have been well documented, with complications such as infection, extrusion, capsular contracture, and failed reconstruction reported in 20% to 70% of cases.1-3 In this article, based on a single surgeon’s experience with 21 patients who underwent breast irradiation and tissue expander/implant breast reconstruction, the authors reported that compared with patients who did not undergo radiation therapy, those who did undergo this therapy experienced a higher rate of seroma formation (5%), infection (15%), delayed healing (5%), implant exposure (10%), and systemic complications. However, the authors concluded that the overall complication rate (7%) was low and that the rate of successful reconstruction was high. I am somewhat confused by this conclusion and by how the overall complication rate was calculated. The authors also failed to mention how many of these patients lost their expanders/implants as a result of infection, exposure, or severe capsular contracture and how many patients’ adjuvant therapy was delayed as a result of these complications. Because breast reconstruction is an elective procedure and its goal is to improve the patient’s quality of life, optimal reconstructive methods should have minimal complications.
Breast Diseases: A Year BookÒ Quarterly Vol 19 No 4 2009
Particularly when immediate breast reconstruction is performed, the reconstructive method needs to be safe and reliable with minimal complications so that adjuvant therapy, if needed, is not delayed. Other studies have advocated the use of implant-based breast reconstruction in patients who undergo radiation therapy and have suggested that prosthetic reconstruction is a reasonable option for many of these patients; however, this study does not seem to support this conclusion.2,3 D. W. Chang, MD
References 1. Spear S, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105:930-942. 2. Ascherman JA, Hanasono MM, Newman MI, Hughes DB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconst Surg. 2006; 117:359-365. 3. Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results and satisfaction among 156 patients. Plast Reconstr Surg. 2004;113:877-881.