Complication Rates of Radiation on Tissue Expander and Autologous Tissue Breast Reconstruction
To evaluate risk factors for complications of tissue expander/implant and autologous tissue breast reconstructions and determine if radiation increases complication rates.
Materials and Methods
We performed a retrospective review of patients who underwent mastectomy plus autologous tissue or expander/implant reconstruction at the Cleveland Clinic. Univariate and multivariate analysis were performed in each group to evaluate for risk factors for complications. A complication was considered major if it required reoperation. A predictive model was used to compare the 2 groups to one another.
A total of 1037 patients were included in the study. In the tissue expander/implant population, there was a total complication rate of 31.8% and overall major complication rate of 24.4%. Radiation increased the major complication rate from 21.2 to 45.4%. However, 70.1% of the radiated patients ultimately had a successful implant-based reconstruction while an additional 10.3% went on to have autologous reconstruction. Age and body mass index (BMI) > 30 also led to higher major complication rates in tissue expander/implant reconstruction while smoking, hypertension, and chemotherapy had no impact. In the autologous reconstruction group, there was a total complication rate of 31.5% and a major complication rate of 19.7%. There was no statistically significant difference between the radiated and nonradiated autologous tissue reconstructions with major complication rates of 17.9 and 20.5%, respectively. BMI > 30 was the only significant factor leading to higher major complications in the autologous reconstructions.
Total complication rates were similar between tissue expander and autologous reconstructions. Increased major complication rates in patients with tissue expander reconstructions occurred in those with radiation, but was still successful in the majority of patients. Radiation had no influence on autologous tissue reconstruction major complication rates.
KeywordsComplication Rate Breast Reconstruction Postoperative Radiation Capsular Contracture Flap Reconstruction
- 6.Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia Randomized Trial. J Natl Cancer Inst. 2005;97:116–26.CrossRefPubMedGoogle Scholar
- 8.R Development Core Team, R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing, Vienna, Austria, 2009.Google Scholar
- 9.Harrell FE. Design: Design Package, v 2.3-0., 2009.Google Scholar
- 12.Tallet AV, Salem N, Moutardier V, Ananian P, Braud AC, Zalta R, et al. Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results. Int J Rad Oncol Bio Phys. 2003;57:136–42.Google Scholar
- 29.Brooks S, Dietz J, Djohan R, et al. Risk factors for complications of radiation therapy on tissue expander breast reconstruction. Poster presentation at the 2009 Society of Surgical Oncology Meeting.Google Scholar