by Kim, Ara; Bae, Juyoung; Bang, Sa-Ik; Pyon, Jai-Kyong
Plastic and Reconstructive Surgery: February 2022
- Volume 149 - Issue 2 - p 185e-194e
Background: Time intervals for expander-to-implant exchange
from radiation therapy have been reported to reduce device failure. This study
investigated the optimal timing of expander-to-implant exchange after
irradiation in terms of short- and long-term outcomes.
Methods: This retrospective review enrolled consecutive
patients who underwent immediate two-stage breast reconstruction and radiation
therapy to tissue expanders from 2010 to 2019. Receiver operating
characteristic curves and the Youden index were used to estimate the optimal
time from radiation therapy to implant placement in terms of 49-day (early) and
2-year (late) complications. Logistic regression analysis was performed to
identify the risk factors for each complication.
Results: Of the 1675 patients, 133 were included. The 49-day
and 2-year complication rates were 8.3 percent and 29.7 percent, respectively.
Capsular contracture was the most common 2-year complication. The Youden index
indicated that implant placement at 131 days after radiation therapy was most
effective in reducing the 49-day complications, but that the 2-year
complication was less significant, with lower sensitivity and area under the
curve. Modified radical mastectomy, expander fill volume at radiation therapy,
and size of permanent implant increased the odds of 49-day complications; none
of them was associated with the odds of 2-year complications.
Conclusions: To reduce short-term complications, the best
time point for permanent implant placement was 131 days after radiation
therapy. However, there was no significant time interval for reducing long-term
complications. Capsular contracture was an irreversible complication of
radiation injury that was not modified by postirradiation variables including
the time from irradiation or size of permanent implant. CLINICAL QUESTION/LEVEL
OF EVIDENCE: Therapeutic, III.
