SS 12 - Breast 1 - Toxicity
88 - Comparing 10 Year Outcomes With Salvage Mastectomy Followed By Immediate Autologous Reconstruction or Tissue Expander/Implant Based Reconstruction in Patients With Locally Recurrent Breast Cancer After Breast Conservation Therapy
Monday, October 22
11:35 AM - 11:45 AM
Location: Room 214 C/D
Bindu Manyam, MD
Cleveland Clinic: Resident Physician: Employee; Vitreo-retinal Consultants: Staff Physician: Employee; Vitreo-Retinal Consultants: Staff Physician: Employee; Vitreo-retinal Consultants: Staff Physician: Employee
Comparing 10 Year Outcomes With Salvage Mastectomy Followed By Immediate Autologous Reconstruction or Tissue Expander/Implant Based Reconstruction in Patients With Locally Recurrent Breast Cancer After Breast Conservation Therapy
B. Manyam1, C. S. Shah1, N. M. Woody1, A. Juloori1, C. A. Wengler2, S. Valente2, S. Grobmyer2, N. Kundu3, R. Djohan3, and R. D. Tendulkar1; 1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 2Department of Breast Surgery, Cleveland Clinic, Cleveland, OH, 3Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
Purpose/Objective(s): Salvage mastectomy (SM) is the standard of care for patients (pts) with local recurrence (LR) after breast conservation therapy (BCT), and pts often elect immediate reconstruction. With previously irradiated tissue, concerns regarding reconstruction toxicity exist. Long-term data comparing toxicity outcomes between tissue expander/implant reconstruction (TE/I) and autologous reconstruction (AR) techniques are limited. We sought to compare rates of complications requiring re-operation (CRR) and reconstruction failure (RF) between AR and TE/I in pts who previously received BCT and underwent SM and immediate reconstruction for LR.
Materials/Methods: Pts with locally recurrent breast cancer after BCT, treated by SM and immediate AR or TE/I between 2000 to 2008 were identified in an IRB-approved database. CRR was defined as an unplanned return to the operating room for wound infection, dehiscence, skin/flap necrosis, 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 a flat chest wall. Complication rates were compared using Pearson’s Chi-squared test. Cumulative incidence of CRR and RF was calculated using Kaplan Meier method and compared using log-rank test. Logistic regression was used to identify factors associated with CRR and RF.
Results: This study included 103 pts with 107 reconstructions. There were 73 AR (68%) and 34 TE/I (32%) and median follow up was 6.6 years (yrs). The median time between BCT and reconstruction was not significantly different between AR and TE/I (5.5 vs. 3.6 yrs; p=0.66), respectively. Age, BMI, RT dose, active smoking, diabetes, and hypertension were similar between AR and TE/I. Wound infection (9.6% vs. 20.6%; p=0.12) and dehiscence (9.6% vs. 11.8%; p=0.73) were not significantly different for AR and TE/I, respectively. Skin/flap necrosis was significantly higher for AR (30.1% vs. 8.8%; p=0.015). For TE/I, rate of implant removal due to infection was 17.6%, capsular contracture was 23.5%, and extrusion was 26.5%. The rate of CRR was significantly higher with TE/I compared to AR at 5 yrs (50.0% vs. 23.3%) and 10 yrs (52.9% vs. 24.7%); p=0.011. Rate of RF was significantly higher with TE/I compared to AR at 5 yrs (41.2% vs. 5.5%) and 10 yrs (44.1% vs. 5.5%); p < 0.001. On UVA, TE/I was the only significant predictor for higher CRR (OR 3.4; p=0.004) and RF (OR 10.7; p<0.001).
Conclusion: In this population of previously irradiated pts at high risk for reconstruction complications, TE/I was associated with significantly higher rate of unplanned re-operation and RF. The risk of complications plateaus after 2 yrs for AR, while complications may occur up to 10 yrs after TE/I. AR should be considered in appropriately selected pts.
Author Disclosure: B. Manyam: Employee; Vitreo-retinal Consultants. C.S. Shah: Employee; Cleveland Clinic Foundation. Consultant; Impedimed. N.M. Woody: None. C.A. Wengler: None. S. Grobmyer: None. N. Kundu: None. R. Djohan: None. R.D. Tendulkar: None.