Surgical Outcomes of Mastectomy with Immediate Autologous Reconstruction Followed by Radiation
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Surgical Outcomes of Mastectomy with Immediate Autologous Reconstruction Followed by Radiation Danielle R. Heller, MD, MHS1 , Haoran Zhuo, MPH2, Yawei Zhang, MD, PhD2, Nisha Parikh, PA-C3, Stefano Fusi, MD, MBA1, Michael Alperovich, MD, MSc4, Donald R. Lannin, MD5, Susan A. Higgins, MD3, Tomer Avraham, MD4, and Brigid K. Killelea, MD, MPH5 Department of Surgery, Yale University School of Medicine, New Haven, CT; 2School of Public Health, Yale University School of Medicine, New Haven, CT; 3Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT; 4Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT; 5The Breast Center, Department of Surgery, Yale University School of Medicine, New Haven, CT 1
ABSTRACT Introduction. Timing of autologous reconstruction relative to postmastectomy radiation therapy (PMRT) is debated. Benefits of immediate reconstruction must be weighed against a possibly heightened risk of complications from flap irradiation. We reviewed flap outcomes after single operation plus PMRT in a large institutional cohort. Methods. Medical records were reviewed for women who underwent simultaneous mastectomy–autologous reconstruction with PMRT from 2007 to 2016. Primary endpoints were rates and types of radiation-related flap complications and reoperations, whose predictors were assessed by multivariable analysis. A p value \ 0.10 was deemed significant to avoid type II error. Non-parametric logistic regression generated a model of PMRT timing associated with probabilities of complications and reoperations. Results. One-hundred and thirty women underwent 208 mastectomy reconstruction operations, with a median follow up of 35.1 months (interquartile range 23.6–56.5).
This study was presented at the Society of Surgical Oncology 72nd Annual Cancer Symposium 2019, where it was awarded Top 25% in the Breast Cancer Track.
Forty-seven (36.2%) women experienced radiation-related complications, commonly fat necrosis (44.1%) and chest wall asymmetry (28.8%). Complications were higher among women who received PMRT \ 3 months after surgery (46.8% for \ 3 months vs. 29.3% for C 3 months; p = 0.06), most of whom received neoadjuvant chemotherapy, and among women treated with internal mammary nodal (IMN) radiation (65.2% vs. 26.4%; p \ 0.01); IMN radiation remained strongly associated in multivariable analysis (odds ratio [OR] 5.24; p \ 0.01). Thirty-two (24.6%) women underwent 70 reoperations, commonly fat grafting (51.9%) and fat necrosis excision (17.1%). Reoperations were higher among women who received PMRT \ 3 months after surgery (48.9 for \ 3 months vs. 36.6 for C 3 months; p = 0.19), which was significantly associated in multivariable analysis (OR 0.42; p = 0.08 for C 3 months). The probabilities of complications and reoperations were lowest when PMRT was administered C 3 months after surgery. Conclusions. Among a large institutional cohort, immediate autologous reconstruction was associated with simila
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