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Optimal Timing for Expander to Implant Exchange After Postmastectomy Radiation Therapy.
Matthew A DePamphilis1, Yunchan Chen1, Madeleine N McGlynn1
1From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.
Annals of Plastic Surgery
|July 9, 2026
Summary
Waiting at least 6.87 months for breast implant exchange after postmastectomy radiation therapy (PMRT) reduces complication risks. This delay optimizes outcomes for two-stage breast reconstruction patients.
Area of Science:
- Plastic Surgery
- Oncology
- Radiotherapy
Background:
- Optimal timing for tissue expander to implant exchange after postmastectomy radiation therapy (PMRT) is unclear.
- Radiation therapy can negatively impact wound healing and increase infection risk.
- Limited evidence exists on safe intervals for second-stage breast reconstruction post-PMRT.
Purpose of the Study:
- To determine the optimal time interval for implant exchange after PMRT.
- To minimize postoperative complications in two-stage breast reconstruction.
- To provide evidence-based guidance for surgical decision-making.
Main Methods:
- Multicenter retrospective cohort study (2016-2025).
- Included patients undergoing two-stage breast reconstruction with PMRT to the tissue expander.
- Primary outcome: 90-day complication rate after permanent implant placement.
Main Results:
- A sample of 298 patients was analyzed.
- The optimal interval delay for implant exchange was identified as >6.87 months (AUC=0.558).
- Exchanging implants earlier (<6.87 months) was associated with higher complication rates (14.8% vs. 6.7%), including infection and wound dehiscence.
Conclusions:
- Delaying second-stage reconstruction to at least 6.87 months post-PMRT is linked to fewer complications.
- This timeframe can help optimize patient outcomes.
- Findings can improve preoperative risk counseling for breast reconstruction patients.
