Dataset Information

Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy

ABSTRACT:

Background and purpose

Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material.

Materials and methods

Retrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications.

Results

251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23–9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60–4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97–11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048–0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26–9.99, p = 0.016) were related to late complications.

Conclusions

The overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.

SUBMITTER: Stuart S

PROVIDER: S-EPMC8575365 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:PurposeThe goal of this study was to explore the perspectives and practice of radiation oncologists who treat breast cancer patients who have had breast reconstruction.MethodsIn 2010, an original electronic survey was sent to all physician members of the American Society of Radiation Oncology, National Cancer Research Institute-Breast Cancer Studies Group in the United Kingdom, Thai Society of Therapeutic Radiology and Oncology, Swiss Society of Radiation Oncology, and Turkish Radiation Oncology Society. We identified factors associated with radiation oncologists who treat breast cancer patients with reconstruction performed prior to radiation and obtained information regarding radiation management of the breast reconstruction.Results358 radiation oncologists responded, and 60% of the physicians were from the United States. While 64% of participants agree or strongly agree that breast image affects a woman's quality of life during radiation, 57% feel that reconstruction challenges their ability to deliver effective breast radiation. Compared with other countries, treatment within the United States was associated with a high reconstruction rate (>/= 50% of mastectomy patients) prior to radiation (p < 0.05). Delayed-immediate reconstruction with a temporary tissue expander was more common in the United States than in other countries (52% vs. 23%, p = 0.01). Among physicians who treat patients with tissue expanders, the majority (60%) prefer a moderately inflated implant with 150-250 cc of fluid rather than a completely deflated (13%) or inflated expander (28%) during radiation. Among radiation oncologists who treat reconstructions, 49% never use bolus and 40% never boost a breast reconstruction. United States physicians were more likely than physicians from other countries to boost or bolus the reconstruction irrespective of the type of reconstruction seen in their clinic patients (p < 0.01).ConclusionsGreat variation in practice is evident from our study of radiation treatment for breast cancer patients with reconstruction. Further research on the impact and delivery of radiation to a reconstructed breast may validate some of the observed practices, highlight the variability in treatment practice, and help create a treatment consensus.

Project description:BackgroundThe risk factors for breast implant reconstruction complications and prosthetic reconstruction failure are currently inconclusive. Besides, there is a lack of studies regarding the relationship between radiation dose distribution and complications. This study explored the risk factors for breast implant reconstruction complications and analyzed the influence of radiation dose distribution on complications.MethodsPatients undergoing breast prosthesis reconstruction between January 2012 and June 2020 were retrospectively reviewed. Patient demographics, treatments, and perioperative factors were recorded, as well as complications and prosthetic reconstruction failures. Multivariable logistic regression models were used to explore the risk factors of reconstruction complications and prosthesis reconstruction failure. The radiation dose distribution was obtained by examining the dose-volume histogram and compared among patients with and without complications.ResultsTwo hundred and sixteen patients (221 reconstructions) were not irradiated, whereas 59 (59 reconstructions) received radiotherapy (RT). The median follow-up period was 47.7 months. Multivariate regression analysis showed that RT [odds ratio (OR) =2.000; 95% confidence interval (CI): 1.065-3.754; P=0.031] and chemotherapy (OR =2.226; 95% CI: 1.032-4.799; P=0.041) were independent risk factors for overall reconstruction complications; and hypertension (HT) (OR =8.222; 95% CI: 1.056-64.034; P=0.044) or RT (OR =2.442; 95% CI: 1.009-5.908; P=0.048) were risk factors for prosthetic reconstruction failure. There was a statistically significant difference in the radiation dose distribution between patients with and those without complications. Patients with complications had a significantly higher mean dose of 5 or 10 cc around the maximum radiation dose in the planning target volume (PTV) (P=0.045 and P=0.034, respectively), irradiation volume with a dose of 107% of prescription dose (P=0.027), and proportion of irradiation volume with doses of 105% and 107% of prescription dose to the total PTV (P=0.019 and P=0.042, respectively).ConclusionsRT can increase implant reconstruction complications and prosthetic reconstruction failure, but remains an acceptable option in a multidisciplinary setting. In addition to RT, chemotherapy is a risk factor for overall complications of breast implant reconstruction. HT is a risk factor for prosthetic reconstruction failure, so the patient's blood pressure should be actively monitored and controlled during the perioperative period. The radiation dose level and the volume with high-dose radiation should be limited to reduce complications.