Long-term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant-based reconstruction.
Adult
Aged
Aged, 80 and over
Breast Implants
/ adverse effects
Breast Neoplasms
/ radiotherapy
Female
Free Tissue Flaps
/ adverse effects
Humans
Mammaplasty
/ adverse effects
Mastectomy, Segmental
/ adverse effects
Middle Aged
Neoplasm Recurrence, Local
/ surgery
Postoperative Complications
/ epidemiology
Prospective Studies
Reoperation
Tissue Expansion
/ adverse effects
autologous
breast cancer
expander
reconstruction
toxicity
Journal
The breast journal
ISSN: 1524-4741
Titre abrégé: Breast J
Pays: United States
ID NLM: 9505539
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
28
09
2018
revised:
26
11
2018
accepted:
17
12
2018
pubmed:
3
7
2019
medline:
9
4
2020
entrez:
3
7
2019
Statut:
ppublish
Résumé
Salvage mastectomy (SM) is the standard of care for patients with local recurrence (LR) after breast conservation therapy (BCT), often with immediate reconstruction. Complications of reconstruction are a concern for these patients, and long-term data are limited. We sought to compare rates of complications requiring re-operation (CRR) and reconstruction failure (RF) between autologous reconstruction (AR) and tissue expander/implant reconstruction (TE/I). Patients with locally recurrent breast cancer after BCT, treated with SM and immediate AR or TE/I between 2000 and 2008, were identified. CRR was defined as unplanned return to operating room for wound infection, dehiscence, necrosis (including flap, skin, or fat), hematoma, or hernia (for AR) and extrusion, leak, or capsular contracture (for TE/I). RF was defined as conversion to another reconstruction technique or to flat chest wall. This study included 103 patients with 107 reconstructions. Median follow-up was 6.6 years. CRR and RF were significantly higher with TE/I (n = 34) compared to AR (n = 73) at 5 years (50.9% vs 25.5%; P = 0.02) and (42.1% vs 5.8%; P < 0.001). On univariate analysis (UVA), TE/I (HR = 2.14; P = 0.02) and diabetes (HR = 5.10; P = 0.007) were significant predictors for CRR. On UVA, TE/I (HR = 7.30; P < 0.001) and older age at reconstruction (HR = 1.03; P = 0.003) were significant predictors for RF. In this population of previously irradiated patients, TE/I was associated with significantly higher CRR and RF. Complications continue to occur up to 10 years after TE/I. AR should be considered in appropriately selected patients, though TE/I may remain a reasonable option in patients without high-risk factors for surgical complications.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1071-1078Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
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