Timing of radiation and outcomes in implant-based breast reconstruction

Limited data exist regarding the effect of radiation timing on complications of tissue expander/implant-based breast reconstruction. This study seeks to compare outcomes of tissue expander/implant reconstruction in patients undergoing postmastectomy radiotherapy, those with previous radiation therapy following breast conservation therapy, and those who did not receive radiation therapy.

The records of the patients of a single surgeon were reviewed from January 2007 to July 2013. All patients undergoing tissue expander/implant breast reconstruction were placed into one of three groups based on the timing of radiation therapy: postmastectomy (Current), previously following breast conservation therapy (Prior), and no radiotherapy (No XRT). Medical records were reviewed for any reported complications, and statistical analysis was performed.

A total of 210 patients (265 breasts) were included in the analysis. Current patients were more likely than No XRT patients to experience expander infection (20% vs. 2.6%, p = 0.001) and expander removal (26% vs. 8.3%, p = 0.007). Prior patients were more likely than No XRT patients to undergo conversion to tissue flap reconstruction (10.5% vs. 0.6%, p = 0.031). No significant differences were found between groups with respect to cellulitis, abscess formation, hematoma, seroma, skin flap necrosis, expander exposure, implant exposure, or implant infection.

This study supports the relative safety of tissue expander/implant breast reconstruction in selected groups of patients who have received radiation therapy. Differences in rates of expander infection, expander removal, and conversion to tissue flap reconstruction represent potential areas for further research.