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Factors affecting complications in radiated breast reconstruction
Ivo A Pestana1, Douglas C Campbell, Gaurav Bharti
1From the Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-1075, USA.
Annals of Plastic Surgery
|April 2, 2013
Summary
Breast reconstruction after radiation therapy increases complication risks, particularly when using acellular dermal matrices (ADMs). Radiation timing and reconstruction type did not significantly impact outcomes, but ADMs raised reoperation rates.
Area of Science:
- Oncology
- Plastic Surgery
- Radiotherapy
Background:
- Breast irradiation combined with reconstruction increases complication rates.
- Radiotherapy use in breast reconstruction is rising due to lower thresholds.
- Identifying factors influencing outcomes in irradiated breast reconstructions is crucial.
Purpose of the Study:
- To evaluate factors affecting outcomes in patients undergoing breast reconstruction after radiation therapy.
- To analyze the impact of reconstruction timing, type, and use of acellular dermal matrices (ADMs) on complication rates.
Main Methods:
- Retrospective review of 154 patients (157 reconstructions) undergoing mastectomy, radiation, and breast reconstruction.
- Data collected included patient demographics, reconstruction type (autologous vs. implant-based), ADM use, radiation timing (pre- vs. post-reconstruction), and postoperative complications.
Main Results:
- Major complications occurred in 43% of patients, with minor complications in 17%.
- The use of ADMs significantly increased the risk of reoperation (2.3-fold, P = 0.03).
- No significant differences in complication rates were found based on hypertension, diabetes, smoking, BMI, reconstruction type, or radiation timing.
Conclusions:
- Radiation therapy following prosthetic breast reconstruction may increase failure rates.
- Acellular dermal matrices (ADMs) significantly increase the likelihood of complications requiring reoperation in irradiated breast reconstructions.
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