Radiation Therapy and Breast Reconstruction, a Retrospective Analysis of Reoperation Rates
Jiaxi Chen1, Harsh Patel1, Robert Tung1, Vivian Hu1, Edward Ray1 1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles
Background: After being diagnosed with breast cancer, patients are faced with a complex set of decisions regarding surgical options in breast reconstruction. Postmastectomy radiation therapy (PMRT) plays a major role in determining the optimal timing and technique utilized in breast reconstruction, with multifactorial options including immediate or delayed and prosthetic, autologous, or hybrid reconstruction. We report a single center experience of patients who underwent mastectomy with reconstruction to demonstrate how PMRT affects the number of planned and unplanned procedures.
Methods: Patients who underwent unilateral or bilateral mastectomy followed by breast reconstruction from 2008 to 2019 at Cedars-Sinai Medical Center (Los Angeles, CA) were included in study. Patients without at least 6 months of follow up after final reconstruction were excluded. The primary endpoint was defined to be reoperation, which was further categorized as planned, unplanned, or urgent. Planned reoperation encompassed reoperations related to completion of staged procedures. Unplanned reoperation encompassed reoperation related to complications of the original procedure. Urgent reoperations were complications of the original surgery which necessitated takeback to the OR in less than 24 hours' time. Multivariable Poisson regression analysis was employed to model the correlation between patient factors and overall reoperation and unplanned reoperation.
Results: From 2008 to 2019, we find 953 women underwent unilateral or bilateral mastectomy. 654 patients underwent 1,132 breast reconstructions. Mean age was 51.5 years, 75.5% of patients identified as non-Hispanic Caucasian, 80.1% were privately insured, and average BMI was 25.1 kg/m2. 470 patients underwent tissue expander to implant reconstruction, 61 patients underwent direct-to-implant reconstruction, 58 patients underwent hybrid latissimus dorsi with immediate implant reconstruction, and 53 underwent autologous reconstruction. In regard to radiation therapy, 229 (35.0%) patients had a history of chest radiation therapy, of these patients 159 (24.3%) had PMRT. 80.7% of patients required at least one reoperation with 67% of patients requiring at least one planned reoperation and 40% of patients requiring at least one unplanned reoperation, and 6.7% of patients underwent at least one urgent reoperation. Subgroup analysis revealed no statistical difference in overall reoperation rate with PMRT (81% versus 79%, p>0.56). However, unplanned reoperation rate was higher in patients who have had chest radiation compared to patients who have not had chest radiation (47% versus 36%, p<0.03).
Conclusion: Reconstruction following mastectomy is a multifactorial decision factoring in patient goals, disease pathology, and adjuvant therapy. We report the number of planned and unplanned reoperations in addition to original reconstructions for all patients, comparing reconstruction in patients with and without chest radiation. The data presented herein is vital in instructing patients on the relative number of procedures they will have to undergo. We find radiation therapy can significantly influence the outcome of breast reconstruction and the need for reoperation afterwards. Understanding the effects of chest radiation can help improve preoperative patient counseling in breast reconstruction.
Back to 2021 Abstracts