Breast Cancer

SS 12 - Breast 1 - Toxicity

90 - Comparing 10 Year Outcomes in Radiated Patients With Breast Autologous Reconstruction (AR) or Tissue Expander/Implant Based Reconstruction (TE/I)

Monday, October 22
11:55 AM - 12:05 PM
Location: Room 214 C/D

Comparing 10 Year Outcomes in Radiated Patients With Breast Autologous Reconstruction (AR) or Tissue Expander/Implant Based Reconstruction (TE/I)
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): Post-mastectomy radiation therapy (PMRT) is associated with higher rates of breast reconstruction complications. The optimal approach for reconstruction with PMRT remains indeterminate, as toxicity profiles vary by technique and timing, and long-term data are limited. We sought to compare rates of complications requiring re-operation (CRR) and reconstruction failure (RF) between upfront autologous reconstruction (U-AR), upfront tissue expander/implant reconstruction (U-TE/I), delayed AR (D-AR), and delayed TE/I (D-TE/I) in pts who received PMRT.

Materials/Methods: Pts who received AR or TE/I, and PMRT between 2000-2008 were identified in an IRB-approved database. Pts underwent either upfront reconstruction on the same day as mastectomy followed by PMRT (U-AR or U-TE/I) or delayed reconstruction following PMRT (D-AR and D-TE/I). CRR was defined as an unplanned return to the operating room due to wound infection, dehiscence, skin and/or flap necrosis, hematoma, or hernia (with AR) and extrusion, leak, or capsular contracture (with TE/I). RF was defined as an unplanned conversion to another reconstruction technique or to a flat chest wall. Cumulative incidence of CRR and RF was calculated using Kaplan Meier method and compared using log-rank test. Logistic regression analysis was used to identify variables associated with CRR and RF.

Results: This study included 230 pts with 233 reconstructions. There were 143 AR (61%) and 90 TE/I (39%), and median follow up was 7.6 years (yrs). Upfront reconstruction was performed in 81% of pts. Age, BMI, active smoking, diabetes, and hypertension were similar between AR and TE/I. Rates of CRR (p=0.009) and RF (p<0.001) were significantly higher with TE/I compared to AR, overall. Table 1 summarizes the rate of CRR and RF by reconstruction technique and timing. On multivariate analysis, TE/I (OR 2.4; p=0.007), BMI ≥ 30 (OR 3.4; p=0.002), and active smoking (OR 2.7; p=0.002) were significant predictors for CRR, and TE/I (OR 5.4; p <0.001) was the only significant predictor for RF. When RF due to wound infection was excluded, the rate of RF was not significantly different between the four groups (p=0.156). Most CRR occurred within the first two yrs, while RF could be observed up to ten yrs after upfront reconstruction. 

Conclusion: In the setting of PMRT, TE/I reconstruction in the upfront and delayed setting is associated with higher CRR and RF compared to AR. Efforts to minimize RF with TE/I and PMRT should focus on minimizing risks for infection.

 

Table 1: Rate of CRR and RF by Reconstruction Technique and Timing

 

 

CRR

 

 

RF

 

2 yr

5 yr

10 yr

p-value

 

2 yr

5 yr

10 yr

p-value

U-AR (n=106)

18.9%

19.8%

20.8%

0.015

U-AR (n=106)

3.8%

4.7%

5.7%

< 0.001

U-TE/I (n=82)

32.9%

36.5%

39.0%

U-TE/I (n=82)

13.4%

20.7%

24.4%

D-AR (n=37)

29.7%

33.3%

32.4%

 D-AR (n=37)

2.7%

5.4%

5.4%

D-TE/I (n=8)

62.5%

62.5%

62.5%

 D-TE/I (n=8)

50.0%

50.0%

50.0%

 

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.

Bindu Manyam, MD

Disclosure:
Employment
Cleveland Clinic: Resident Physician: Employee; Vitreo-retinal Consultants: Staff Physician: Employee; Vitreo-Retinal Consultants: Staff Physician: Employee; Vitreo-retinal Consultants: Staff Physician: Employee

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