Optimizing Breast Reconstruction Outcomes in the Setting of Radiation Therapy: A Retrospective Cohort Study

• Type of Material: Article
• Authors: Sara Kebede, Emory University; Anjali Om, Emory University; Peter Thompson, Emory University
• Language: English
• Date: 2023-10-18
• Publisher: Wolters Kluwer Health Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1097/01.GOX.0000991984.15206.71
• Title of Journal or Parent Work: Plastic and Reconstructive Surgery-Global Open
• Volume: 11
• Issue: 10 Suppl
• Start Page: 24
• End Page: 25
• Keywords: postmastectomy radiation therapy; breast cancer treatment; Breast reconstruction; mastectomy
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Oncology

Abstract

BACKGROUND: Breast reconstruction is a vital aspect of breast cancer treatment, providing significant improvements to quality of life for patients who have undergone mastectomy. While postmastectomy radiation therapy (PMRT) also plays a pivotal role in treatment for many patients, its benefits often come at the cost of compromising breast reconstruction outcomes. As such, identifying approaches that optimize reconstructive outcomes is of particular importance in this population. METHODS: We conducted a retrospective chart review of consecutive patients who underwent postmastectomy breast reconstruction at a single institution. Eligible patients were those who received PMRT, and data collected included patient demographics, comorbidities, operative details, and postoperative complications. The primary outcomes assessed were mastectomy skin flap necrosis (MSFN) and reconstruction failure, defined as the removal of the tissue expander or implant due to any complication. Reconstruction failure specifically due to infection was also collected. RESULTS: Among the 684 patients initially identified, 156 met the inclusion criteria for the study. Skin-sparing mastectomies were the most common approach used in this cohort (57%), followed by nipple-sparing mastectomies (41%) and skin-reducing mastectomies (2%). The majority of patients underwent prepectoral reconstruction (70%) compared to subpectoral (30%). Mastectomy approach and reconstruction plane were not associated with reconstructive outcomes, whereas comorbidities were significantly associated with complications. Specifically, BMI was associated with an increased incidence of MSFN (p=0.026), while diabetes was associated and positively correlated with both MSFN (p=0.007, r=0.260) and any-cause reconstruction failure (p=0.043, r=0.186). Smoking was also associated and positively correlated with higher rates of any-cause (p=0.043, r=0.186) and infection-specific (p=0.031, r=0.219) reconstruction failure. Furthermore, MSFN was positively correlated with any-cause (r=0.340) and infection-specific (r=0.222) reconstruction failure. CONCLUSION: Operative decisions including type of mastectomy and plane of reconstruction did not significantly impact MSFN or reconstruction failure; whereas BMI, diabetes, and smoking were all significantly associated with complications. Our findings highlight the importance of identifying and addressing modifiable risk factors in the preoperative setting in order to optimize reconstruction outcomes in patients receiving PMRT.