Annals of Surgical Oncology

, Volume 17, Supplement 3, pp 202–210 | Cite as

Complication Rates of Radiation on Tissue Expander and Autologous Tissue Breast Reconstruction

  • Tiffany Berry
  • Suzanne Brooks
  • Nicole Sydow
  • Risal Djohan
  • Benjamin Nutter
  • Joanne Lyons
  • Jill Dietz
American Society of Breast Surgeons



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.


Complication Rate Breast Reconstruction Postoperative Radiation Capsular Contracture Flap Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Overgaard M, Hansen PS, Overgaard J, Rose C, Anderson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997;337:949–55.CrossRefPubMedGoogle Scholar
  2. 2.
    Ragaz J, Jackson SM, Le N, Plenderleith IA, Spinelli JJ, Basco VE, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337:956–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c Randomised Trial. Lancet. 1999;353:1641–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Early Breast Cancer Trialists’ Collaborative Group. (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355:1757–70.CrossRefGoogle Scholar
  5. 5.
    Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1539–69.PubMedGoogle Scholar
  6. 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
  7. 7.
    Gebski V, Lagleva M, Keech A, Simes J, Langlands AO. Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective. J. Natl. Cancer Inst. 2006;98:26–38.CrossRefPubMedGoogle Scholar
  8. 8.
    R Development Core Team, R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing, Vienna, Austria, 2009.Google Scholar
  9. 9.
    Harrell FE. Design: Design Package, v 2.3-0., 2009.Google Scholar
  10. 10.
    Siana, JE, Rex S, Gottrup F. The effect of cigarette smoking on wound healing. Scand J Plast Reconstr Surg Hand Surg. 1989;23:207.CrossRefPubMedGoogle Scholar
  11. 11.
    Goldminz D, and Bennet RG. Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatology. 1991;127:1012.CrossRefGoogle Scholar
  12. 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
  13. 13.
    Ascherman JA, Hanasono MM, Newman MI, Hughes DB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg. 2006;117:359–65.CrossRefPubMedGoogle Scholar
  14. 14.
    Goodwin SJ, McCarthy CM, Pusic AL, Bui D, Howard M, Disa JJ, et al. Complications in smokers after postmastectomy tissue expander/implant breast reconstruction. Ann Plast Surg. 2005;55:16–20.CrossRefPubMedGoogle Scholar
  15. 15.
    McCarthy CM, Mehara BJ, Riedel E, Davidge K, Hinson A, Disa JJ, et al. Predicting complications following expander/implant breast reconstruction: An outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg. 2008;121:1886–92.CrossRefPubMedGoogle Scholar
  16. 16.
    Watterson PA, Bostwick J III, Hester RT, Bried JT, Taylor GI. TRAM flap anatomy correlated with a 10-year clinical experience with 556 patients. Plast Reconstr Surg. 1995;95:1185–94.CrossRefPubMedGoogle Scholar
  17. 17.
    Eberlein TJ, Crespo LD, Smith BL. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg. 1993;218:29–36.CrossRefPubMedGoogle Scholar
  18. 18.
    Padubidri AN, Yetman R, Browne E. Complications of postmastectomy breast reconstruction in smokers, ex-smokers and non-smokers. Plast Reconstr Surg. 2001;107:342–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Ducic I, Spear S, Cuoco F, Hannan C. Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis. Ann Plast Surg. 2005;55:559–64.CrossRefPubMedGoogle Scholar
  20. 20.
    Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GR, et al. Effect of smoking on complications in patient undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg. 2000;105:2374–80.CrossRefPubMedGoogle Scholar
  21. 21.
    Alderman A, Wilkins E. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109:2265–74.CrossRefGoogle Scholar
  22. 22.
    Lin KY, Johns FR, Gibsom J, Long M, Drake DB, Moore MM. An outcome study of breast reconstruction: presurgical identification of risk factors for complications. Ann Surg Oncol. 2001;8:586–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Paige KT, Bostwick J, Bried J, Jones G. A comparison of morbidity from bilateral, unipedicled and unilateral, unipedicled TRAM Flap Reconstructions. Plast Reconstr Surg. 1998;101:1819–27.CrossRefPubMedGoogle Scholar
  24. 24.
    Yule GJ, Concannon MJ, Croll, G, Puckett CL. Is there liability with chemotherapy following immediate breast construction? Plast Reconstr Surg. 1996;97:969–73.CrossRefPubMedGoogle Scholar
  25. 25.
    August DA, Wilkins E, Rea T. Breast reconstruction in older women. Surgery. 1994;115:663–8.PubMedGoogle Scholar
  26. 26.
    Krueger EA, Wilkins EG, Strawderman M, Cederna P, Goldfarb S, Vicini FA, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys. 2001;49:713–21.PubMedGoogle Scholar
  27. 27.
    Zimmerman RP, Mark RJ, Kim AL, Walton T, Sayah D, Juillard GF, et al. Radiation tolerance of transverse rectus abdominus myocutaneous-free flaps used in immediate breast reconstruction. Am J Clin Oncol. 1998;21:381–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Tran NV, Evans GRD, Kroll SS, Baldwin BJ, Miller MJ, Reece GP, et al. (2000) Postoperative adjuvant irradiation: effects on transverse rectus abdominus muscle flap breast reconstruction. Plast Reconstr Surg 106:313–7 discussion 318–20.CrossRefPubMedGoogle Scholar
  29. 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
  30. 30.
    Kronowitz SJ, Hunt KK, Kuerer HM, Babiera G, McNeese MD, Buchholz TA, et al. Delayed-immediate breast reconstruction. Plas Reconstr Surg. 2004;113:1617–28.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Tiffany Berry
    • 1
    • 2
  • Suzanne Brooks
    • 1
  • Nicole Sydow
    • 1
  • Risal Djohan
    • 3
  • Benjamin Nutter
    • 4
  • Joanne Lyons
    • 1
  • Jill Dietz
    • 1
  1. 1.Women’s Health Institute, Breast SurgeryCleveland ClinicClevelandUSA
  2. 2.Breast SurgeryNorton Healthcare Surgical SpecialistsLouisvilleUSA
  3. 3.Department of Plastic SurgeryCleveland ClinicClevelandUSA
  4. 4.Department of Quantitative Health SciencesCleveland ClinicClevelandUSA

Personalised recommendations