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Reconstructive failure higher in tissue expander radiation compared to permanent implant radiation

In postmastectomy reconstruction, patients who receive radiation therapy to the tissue expander may achieve better aesthetic outcomes, but are significantly more likely to lose the tissue expander than those undergoing radiation therapy to the final implant.

The retrospective study included breast reconstructions performed by Peter G. Codeiro, MD, of Memorial Sloan-Kettering Cancer Center, from 2003 to 2012. The analysis included 1,486 reconstructions without radiation, 94 reconstructions with tissue expander radiation and 210 reconstructions with permanent implant radiation.

Age and comorbidities were similar across the three groups.

Those who underwent reconstruction without radiation therapy were more likely to use silicone implants, have bilateral reconstructions and require longer follow-up than those undergoing radiation therapy to the tissue expander or permanent implant.

Reconstruction failure was lowest for patients undergoing reconstruction without radiation therapy compared with the two groups undergoing radiation therapy.

Reconstruction failure rates were greater in patients undergoing radiation to the tissue expander (18.1%), compared with patients undergoing radiation to the permanent implant (12.4%).

There was no difference in the number of patients with very good to excellent aesthetic results between the patients undergoing radiation to the tissue expander and those undergoing radiation to the permanent implant.

Patients who did not undergo radiation had significantly higher levels of satisfaction with breasts and outcome and improved psychosocial, physical and sexual well-being than patients who underwent radiation.

The researchers concluded that the reconstructive approach and timing of radiation therapy in this patient cohort will likely continue to evolve. -by Abigail Sutton

Disclosure: Cordeiro received financial and material support from Allergan, Inc., for participating in a multicenter clinical research study. The other authors reported no relevant financial disclosures.