Delay Breast Reconstruction Until After Radiotherapy

NEW ORLEANS—Patients undergoing staged breast reconstruction with saline-filled implants and subsequent radiation therapy experienced more complications and required more replacement procedures than patients who underwent reconstruction without radiation therapy, according to a retrospective study presented at the 68th Annual Scientific Meeting of the American Society of Plastic and Reconstructive Surgeons (now the American Society of Plastic Surgeons).

With the number of patients undergoing radiation therapy for breast cancer increasing dramatically, there is a need for outcome information for staged saline implant reconstruction in irradiated breasts, said Scott Spear, MD, professor and chief, Division of Plastic Surgery, Georgetown University Medical Center.

The investigators retrospectively reviewed 40 consecutive patients who had undergone two-stage saline-filled implant breast reconstruction and radiation therapy between 1990 and 1997.

Most of the group (19 patients) had undergone mastectomy and adjuvant radiation therapy during reconstruction and expansion. Seven patients had undergone previous lumpectomy and radiation therapy; nine patients had mastectomy with radiation therapy before reconstruction, and five patients had radiation therapy after reconstruction.

The control group comprised 40 randomly selected patients who had undergone two-stage saline-filled implant breast reconstructions after radiation therapy.

A total of 32.5% of the patients with irradiated implants experienced capsular contracture and 12.5% experienced infections that required antibiotic treatment. Other complications in the irradiated group included actual extrusion in two patients and threatened extrusion that was salvaged in one patient. The control group experienced two threatened extrusions that were salvaged and two deflations.

Nearly half (47.5%) of the 40 irradiated breasts containing saline implants ultimately needed the addition of, or replacement by, a latissimus dorsi flap. In comparison, only 10% of the 40 patients in the control group with nonirradiated saline implant reconstructions required addition of a flap, and none required replacements.

Latissimus dorsi flaps after radiation therapy have proved to be an excellent solution to the problem of postradiation tissue contracture, which can occur during breast expander reconstruction. But, according to Dr. Spear, it is unwise to use the procedure before or with radiation therapy.

“Reconstructions are more complicated in patients who have had radiation. More often than not, an implant alone won’t be satisfactory,” Dr. Spear said in an interview after the meeting. Therefore, he emphasized, it is important to consider—prior to mastectomy—whether radiation therapy will be necessary, so that the most optimal method of reconstruction can be planned.