by Yoon, Alfred P.; Qi, Ji; Kim, Hyungjin M.; Hamill,
Jennifer B.; Jagsi, Reshma; Pusic, Andrea L.; Wilkins, Edwin G.; Kozlow,
Jeffrey H.
Plastic and
Reconstructive Surgery: May 2020 -
Volume 145 - Issue 5 - p 917e-926e
Background:
Whether to irradiate the tissue expander before implant exchange or to defer
irradiation until after exchange in immediate, two-stage expander/implant
reconstruction remains uncertain. The authors evaluated the effects of
irradiation timing on complication rates and patient-reported outcomes in
patients undergoing immediate expander/implant reconstruction.
Methods:
Immediate expander/implant reconstruction patients undergoing postmastectomy
radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites
with demographic, clinical, and complication data were analyzed.
Patient-reported outcomes were assessed with BREAST-Q, Patient-Reported
Outcomes Measurement Information System, and European Organisation for Research
and Treatment of Cancer Breast Cancer–Specific Quality-of-Life Questionnaire
surveys preoperatively and 2 years postoperatively. Survey scores and
complication rates were analyzed using bivariate comparison and multivariable
regressions.
Results: Of 317
patients who met inclusion criteria, 237 underwent postmastectomy radiation
therapy before expander/implant exchange (before-exchange cohort), and 80 did
so after exchange (after-exchange cohort). Timing of radiation had no
significant effect on risks of overall complications (OR, 1.25; p = 0.46),
major complications (OR, 1.18; p = 0.62), or reconstructive failure (OR, 0.72;
p = 0.49). Similarly, radiation timing had no significant effect on 2-year
patient-reported outcomes measured by the BREAST-Q or the European Organisation
for Research and Treatment of Cancer survey. Outcomes measured by the
Patient-Reported Outcomes Measurement Information System showed less anxiety,
fatigue, and depression in the after-exchange group. Compared with preoperative
assessments, 2-year patient-reported outcomes significantly declined in both
cohorts for Satisfaction with Breasts, Physical Well-Being, and Sexual
Well-Being, but improved for anxiety and depression.
Conclusions:
Radiation timing (before or after exchange) had no significant effect on
complication risks or on most patient-reported outcomes in immediate
expander/implant reconstruction. Although lower levels of anxiety, depression,
and fatigue were observed in the after-exchange group, these differences may
not be clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
