Presenter: Edith Krueger Affiliation: University of Michigan and William Beaumont Hospital
Background: Women undergoing breast implant reconstruction after mastectomy may also require radiation therapy, but data regarding complications and patient satisfaction are limited. The Michigan Breast Reconstruction Outcome Study (MBROS) was designed to evaluate complications, general satisfaction, and aesthetic satisfaction in patients with breast cancer undergoing reconstruction after mastectomy. Materials and Methods:
81 patients receiving an expander/implant reconstruction were identified from the MBROS database as well as from department records.
Surveys were administered to patients 1-2 years after implant surgery. Questions covered general and aesthetic satisfaction.
Responses were scored as 1 (high satisfaction) to 5 (low satisfaction). Only those patients with a 1 or 2 for all items were scored as "satisfied."
Data were also analyzed assuming "dissatisfaction" for patients who did not complete the survey.
Medical records were reviewed for complication data.
19/81 patients received radiation therapy (median dose 60 Gy).
At a median follow-up of 31.5 months, 68% of RT patients developed complications compared to 31% of non-RT patients. Complications most frequently included infection (44 vs. 24%) and capsular contracture (22 vs. 10%).
The RT group had a 37% explantation rate versus 8% for the no RT group (p=0.01).
Tamoxifen was associated with a higher rate of complication (53 vs. 31%, p=0.07) and explantation (58 vs. 0%).
Among the 66 patients who completed the satisfaction surveys, there was no significant difference in general satisfaction or aesthetic satisfaction.
A multivariate logistic regression analysis showed no impact of RT or complications on patient satisfaction, but there was a correlation with tamoxifen use.
Although radiation therapy was associated with an increased rate of complications, general and aesthetic satisfaction were not affected.
The increased adverse findings with tamoxifen use may be due to a correlation with radiation therapy.
One question which could not be addressed in this small study is how the timing of radiation therapy with respect to the implant procedure might affect outcome.
With increasing numbers of women receiving post-mastectomy irradiation, further study of these issues will be needed.
Sep 21, 2010 - In breast cancer patients who undergo immediate breast reconstruction, post-mastectomy irradiation is linked to surgical complications and implant loss, but the risk of noninfectious postoperative complications isn't higher after mastectomy and immediate breast reconstruction in women who receive chemotherapy, according to two studies published in the September issue of the Archives of Surgery.