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DOI: 10.1055/a-2182-1440
The Impact of Timing of Delayed Autologous Breast Reconstruction following Postmastectomy Radiation Therapy on Postoperative Morbidity
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Abstract
Background The ideal time to perform reconstruction after the completion of postmastectomy radiation therapy (PMRT) in patients with locally advanced breast cancer is currently unknown. We evaluate the association between the timing of delayed autologous breast reconstruction following PMRT and postoperative complications.
Methods Patients who underwent mastectomy, PMRT, and then delayed autologous breast reconstruction from 2009 to 2016 were identified from the Truven Health MarketScan Research Databases. Timing of reconstruction following PMRT was grouped 0–3, 3–6, 6–12, 12–24, and after 24 months. Multivariable models were used to assess associations between timing of reconstruction following PMRT and key measures of morbidity.
Results A total of 1,039 patients met inclusion criteria. The rate of any complications for the analytic cohort was 39.4%, including 13.3% of patients who experienced wound complications and 11.3% of patients requiring additional flaps. Unadjusted rates of complications increased from 23.4% between 0 and 3 months to 49.4% between 3 and 6 months and decreased thereafter. Need for additional flaps was highest within 3 to 6 months (14.0%). Multivariate analysis revealed higher rates of any complications when reconstruction was performed between 3 and 6 months (odds ratio [OR]: 3.04, p < 0.001), 6 and 12 months (OR: 2.66, p < 0.001), or 12 and 24 months (OR: 2.13, p = 0.001) after PMRT. No difference in complications were noted in reconstructions performed after 24 months compared with those performed before 3 months (p > 0.05). However, rates of wound complications were least likely in reconstructions after 24 months (OR: 0.34, p = 0.035).
Conclusion These findings suggest plastic surgeons may consider performing autologous breast reconstruction early for select patients, before 3 months following PMRT without increasing postoperative morbidity.
Note
Presented at the Biennial Meeting of the World Society for Reconstructive Microsurgery, June 2019, in Bologna, Italy.
Publikationsverlauf
Eingereicht: 06. Juni 2023
Angenommen: 18. September 2023
Accepted Manuscript online:
26. September 2023
Artikel online veröffentlicht:
01. November 2023
© 2023. Thieme. All rights reserved.
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References
- 1 Overgaard M, Jensen MB, Overgaard J. et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 1999; 353 (9165) 1641-1648
- 2 Overgaard M, Hansen PS, Overgaard J. et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337 (14) 949-955
- 3 McGale P, Taylor C, Correa C. et al; EBCTCG (Early Breast Cancer Trialists' Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383 (9935) 2127-2135
- 4 Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2001; 108 (01) 78-82
- 5 Williams JK, Carlson GW, Bostwick III J, Bried JT, Mackay G. The effects of radiation treatment after TRAM flap breast reconstruction. Plast Reconstr Surg 1997; 100 (05) 1153-1160
- 6 Rogers NE, Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 2002; 109 (06) 1919-1924 , discussion 1925–1926
- 7 Spear SL, Ducic I, Low M, Cuoco F. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg 2005; 115 (01) 84-95
- 8 Kroll SS, Coffey Jr JA, Winn RJ, Schusterman MA. A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions. Plast Reconstr Surg 1995; 96 (04) 860-864
- 9 Carlson GW, Page AL, Peters K, Ashinoff R, Schaefer T, Losken A. Effects of radiation therapy on pedicled transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg 2008; 60: 568-572
- 10 He S, Yin J, Robb GL. et al. Considering the optimal timing of breast reconstruction with abdominal flaps with adjuvant irradiation in 370 consecutive pedicled transverse rectus abdominis myocutaneous flap and free deep inferior epigastric perforator flap performed in a Chinese Oncology center: is there a significant difference between immediate and delayed?. Ann Plast Surg 2017; 78 (06) 633-640
- 11 Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 2004; 114 (04) 950-960
- 12 Nelson JA, Disa JJ. Breast reconstruction and radiation therapy: an update. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction, 5S): 60S-68S
- 13 Ho AY, Hu ZI, Mehrara BJ, Wilkins EG. Radiotherapy in the setting of breast reconstruction: types, techniques, and timing. Lancet Oncol 2017; 18 (12) e742-e753
- 14 Chetta MD, Aliu O, Zhong L. et al. Reconstruction of the irradiated breast: a national claims-based assessment of postoperative morbidity. Plast Reconstr Surg 2017; 139: 783-792
- 15 Wilkins EG, Cederna PS, Lowery JC. et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2000; 106 (05) 1014-1025 , discussion 1026–1027
- 16 Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 2000; 26 (01) 17-19
- 17 Momoh AO, Colakoglu S, de Blacam C, Gautam S, Tobias AM, Lee BT. Delayed autologous breast reconstruction after postmastectomy radiation therapy: is there an optimal time?. Ann Plast Surg 2012; 69 (01) 14-18
- 18 Mull AB, Qureshi AA, Zubovic E. et al. Impact of time interval between radiation and free autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (02) 130-136
- 19 Baumann DP, Crosby MA, Selber JC. et al. Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy. Plast Reconstr Surg 2011; 127 (03) 1100-1106
- 20 Jagsi R, Jiang J, Momoh AO. et al. Complications after mastectomy and immediate breast reconstruction for breast cancer a claims-bas ed analysis. Ann Surg 2016; 263 (02) 219-227
- 21 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
- 22 van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 2009; 47 (06) 626-633
- 23 Frasier LL, Holden S, Holden T. et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in national comprehensive cancer network guidelines. JAMA Oncol 2016; 2 (01) 95-101
- 24 Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 2009; 124 (02) 395-408
- 25 Kelley BP, Ahmed R, Kidwell KM, Kozlow JH, Chung KC, Momoh AO. A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal?. Ann Surg Oncol 2014; 21 (05) 1732-1738
- 26 Lee BTA, Adesiyun T, Colakoglu S. et al. Postmastectomy radiation therapy and breast reconstruction: an analysis of complications and patient satisfaction. Ann Plast Surg 2010; 64: 679-683
- 27 Salvo N, Barnes E, van Draanen J. et al. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol 2010; 17 (04) 94-112
- 28 Wei J, Meng L, Hou X. et al. Radiation-induced skin reactions: mechanism and treatment. Cancer Manag Res 2018; 11: 167-177
- 29 Kung TA, Kidwell KM, Speth KA. et al. Radiation-induced skin changes after postmastectomy radiation therapy: a pilot study on indicators for timing of delayed breast reconstruction. J Reconstr Microsurg 2019; 35: 209-215
- 30 Halle M, Bodin I, Tornvall P, Wickman M, Farnebo F, Arnander C. Timing of radiotherapy in head and neck free flap reconstruction–a study of postoperative complications. J Plast Reconstr Aesthet Surg 2009; 62 (07) 889-895
- 31 Fosnot J, Fischer JP, Smartt Jr JM. et al. Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction?. Plast Reconstr Surg 2011; 127 (02) 496-504
- 32 Schultze-Mosgau S, Grabenbauer GG, Radespiel-Tröger M. et al. Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region. Head Neck 2002; 24 (01) 42-51
- 33 Arnautovic A, Karinja S, Olafsson S. et al. Optimal timing of delayed microvascular breast reconstruction after radiation therapy. J Reconstr Microsurg 2023; 39 (03) 165-170
- 34 Elver AA, Egan KG, Cullom ME. et al. A paradigm shift: outcomes of early autologous breast reconstruction after radiation therapy. J Reconstr Microsurg 2023; 39 (02) 111-119
- 35 Christopher AN, Morris MP, Broach RB, Serletti JM. A comparative analysis of immediate and delayed-immediate breast reconstruction after postmastectomy radiation therapy. J Reconstr Microsurg 2022; 38 (06) 499-505
- 36 Pittelkow E, DeBrock W, Christopher L. et al. Advantages of the delayed-immediate microsurgical breast reconstruction: extending the choice. J Reconstr Microsurg 2022; 38 (07) 579-584
- 37 Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol 2015; 141 (11) 1985-1994