by Dicuonzo, Samantha; Leonardi, Maria Cristina; Radice,
Davide; Morra, Anna; Gerardi, Marianna Alessandra; Rojas, Damaris Patricia;
Surgo, Alessia; Dell’Acqua, Veronica; Luraschi, Rosa; Cattani, Federica;
Rietjens, Mario; De Lorenzi, Francesca; Veronesi, Paolo; Galimberti, Viviana;
Marvaso, Giulia; Fodor, Cristiana; Orecchia, Roberto; Jereczek-Fossa, Barbara
Alicja
Plastic and
Reconstructive Surgery: February 2020
- Volume 145 - Issue 2 - p 317-327
Background: This
study investigated the risk of reconstruction failure after mastectomy,
immediate breast reconstruction, and radiotherapy to either a temporary tissue
expander or permanent implant.
Methods: Records
of women treated at a single institution between June of 1997 and December of
2011 were reviewed. Two patient groups were identified based on type of
immediate breast reconstruction: tissue expander followed by exchange with a
permanent implant and permanent implant. The study endpoint was rate of
reconstruction failure, defined as a replacement, loss of the implant, or
conversion to flap.
Results: The
tissue expander/permanent implant and the permanent implant groups consisted of
63 and 75 patients, respectively. The groups were well balanced for clinical
and treatment characteristics. With a median follow-up of 116 months, eight
implant losses, 50 implant replacements, and four flap conversions were
recorded. Reconstruction failure occurred in 22 of 63 patients in the
expander/implant group and in 40 of 75 patients in the permanent implant group.
A traditional proportional hazards model showed a higher risk of reconstruction
failure for the expander/implant group (hazard ratio, 2.01) and a significantly
shorter time to reconstruction failure compared with the permanent implant
group (109.2 months versus 157.7 months; p = 0.03); however, according to a
competing risk model, the between-groups cumulative incidences were not
significantly different (hazard ratio, 1.09).
Conclusions:
Radiotherapy to either a tissue expander or a permanent implant presented a
fairly large risk of reconstruction failure over time. The expander/implant
group was not more likely to develop reconstruction failure compared to
permanent implant group, but the timing of onset was shorter. More complex
techniques should be investigated to lower the risk of reconstruction failure.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
