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Radiation and depression associated with complications of tissue expander reconstruction

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Abstract

Purpose

Rates of implant failure, wound healing delay, and infection are higher in patients having radiation therapy (RT) after tissue expander (TE) and permanent implant reconstruction. We investigated pretreatment risk factors for TE implant complications.

Patients and methods

127 breast cancer patients had TE reconstruction and radiation. For 85 cases of bilateral TE reconstruction, the non-irradiated breast provided an internal control. Comparison of differences in means for continuous variables used analysis of variance, then multiple pairwise comparisons with Bonferroni correction of p value.

Results

Mean age was 53 ± 10.1 years with 14.6% African-American. Twelve (9.4%) were BRCA positive (9 BRCA1, 4 BRCA2, 1 Both). Complications were: Grade 0 (no complication; 43.9%), Grade 1 (tightness and/or drifting of implant or Baker Grade II capsular contracture; 30.9%), Grade 2 (infection, hypertrophic scarring, or incisional necrosis; 9.8%), Grade 3 (Baker Grade III capsular contracture, wound dehiscence, or impending exposure of implant; 5.7%), Grade 4 (implant failure, exchange of implant, or Baker Grade IV capsular contracture; 9.8%). 15.3% (19 cases) experienced Grade 3 or 4 complication and 9.8% (12 cases) had Grade 4 complication. Considering non-irradiated breasts, there were two (1.6%) Grade 3–4 complications. For BMI, there was no significant difference by category as defined by the CDC (p = 0.91). Patients with depression were more likely to experience Grade 3 or 4 complication (29.4 vs 13.2%; p = 0.01). Using multiple logistic regression to predict the probability of a Grade 3 or 4 complications in patients with depression were found to be 4.2 times more likely to have a Grade 3 or 4 complication (OR = 4.2, p = 0.03).

Conclusions

Higher rates of TE reconstruction complications are expected in patients receiving radiotherapy. An unexpected finding was that patients reporting medical history of depression showed statistically significant increase in complication rates.

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References

  1. Pierce LJ (2005) The use of radiotherapy after mastectomy. A review of the literature. J Clin Oncol 23:1706–1717

    Article  PubMed  Google Scholar 

  2. Cuzick J, Steart H, Peto R (1987) Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer. Cancer Treat Rep 71:15–29

    CAS  PubMed  Google Scholar 

  3. Overgaard M, Hansen PS, Overgaard J et al (1997) Post-operative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337:949–955

    Article  CAS  PubMed  Google Scholar 

  4. Overgaard M, Jensen M, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast- cancer patients given adjuvant tamoxifen: Danish breast cancer cooperative group DBCG 82c randomized trial. Lancet 353:641–1648

    Article  Google Scholar 

  5. Ragaz J, Jackson SM, Le N et al (1997) Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337:956–962

    Article  CAS  PubMed  Google Scholar 

  6. Ragaz J, Olivetto IA, Spinelli JJ et al (2005) Locoregional radiation therapy in patients with high risk breast cancer receiving adjuvant chemotherapy: 20 year results of the British Columbia randomized trial. J Natl Cancer Inst 97:116–126

    Article  PubMed  Google Scholar 

  7. Velez-Garcia E, Carpenter JT Jr, Moore M (1992) Postsurgical adjuvant chemotherapy with or without radiotherapy in women with breast cancer and positive axillary nodes: a South-Eastern cancer study group (SEG) trial. Eur J Cancer 287:1833–1837

    Article  Google Scholar 

  8. Griem KL, Henderson IC, Gelman R et al (1987) The 5 year results of a randomized trial of adjuvant radiation therapy after chemotherapy ion breast cancer patients treated with mastectomy. J Clin Oncol 10:1546–1555

    Article  Google Scholar 

  9. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18:1220–1229

    Article  CAS  PubMed  Google Scholar 

  10. Lebo PB, Quehenberger F, Kamolz L-P, Lumenta DB (2015) The Angelina effect revisited: exploring a media-related impact on public awareness. Cancer 121:3959–3964

    Article  PubMed  Google Scholar 

  11. Colwell AS, Tessler O, Lin AM et al (2014) Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5 year trends. Plast Reconstr Surg 133:496–506

    Article  CAS  PubMed  Google Scholar 

  12. Ibrahim AM, Shuster M, Koolen PG et al (2013) Analysis of the National Surgical Quality Improvement Program Database in 19,100 patients undergoing implant-based breast reconstruction: complication rates with acellular dermal matrix. Plast Reconstr Surg 132:1057–1066

    Article  CAS  PubMed  Google Scholar 

  13. Chuba PJ, Simon MS (1997) Trends in primary surgical and radiation therapy for localized breast cancer in the Detroit Metropolitan area 1973–1992. Int J Radiat Oncol Biol Phys 38:103–107

    Article  CAS  PubMed  Google Scholar 

  14. Chuba PJ, Hamre MR, Yap J, Severson RK, Lucas D, Shamsa F, Aref A (2005) Bilateral risk for subsequent breast cancer after lobular carcinoma-in situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol 2:5534–5541

    Article  Google Scholar 

  15. Krueger EA, Wilkins EG, Strawderman M, Cederna P et al (2001) Complications and patient satisfaction following expander/implant reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49:713–721

    Article  CAS  PubMed  Google Scholar 

  16. Fowble B, Park C, Wang F, Peled A, Alvarado M, Ewing C, Esserman L, Foster R, Sbitany H, Hanlon A (2015) Rates of reconstruction failure in patients undergoing immediate reconstruction with tissue expanders and/or implants and postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 92:634–641

    Article  PubMed  Google Scholar 

  17. Chen SA, Hiley C, Nickleach D et al (2013) Breast reconstruction and post-mastectomy radiation practice. Radiat Oncol 8:45

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hvilsom GB, Holmich LR, Steding–Jessen M et al (2012) Delaying implant reconstruction. Is radiation therapy associated with contracture or reoperations? Ann Plast Surg 68:246

    Article  CAS  PubMed  Google Scholar 

  19. Shah C, Kundu N, Arthur D et al (2013) Radiation therapy in post-mastectomy reconstruction: a systematic review. Ann Surg 20:1313–1322

    Article  Google Scholar 

  20. Pusic AL, Matros E, Buchel E, Gordillo GM, Hamill JB et al (2016) Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. doi:10.1200/JCO2016699561

    PubMed  PubMed Central  Google Scholar 

  21. Jagsi R, Momoh AO, Qi J, et al (2016) Impact of radiotherapy on complications and patient-reported satisfaction with breast reconstruction: findings from the prospective multicenter MROC study. 2016 San Antonio Breast Cancer Symposium. Abstract S3-07. Presented December 8, 2016

  22. Jagsi R, Jiang J, Momoh AO, Alderman A, Giordano SH, Buchholz TA, Pierce LJ, Kronowitz SJ, Smith BD (2016) Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg 263:219–227

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ho AL, Bovill ES, Macadam SA et al (2014) Postmastectomy therapy after immediate two stage tissue expander/implant reconstruction. A University of British Columbia perspective. Plast Reconstruc Surg 134:1e–10e

    Article  CAS  Google Scholar 

  24. Anderson PR, Hanlon AL, Fowble BL et al (2004) Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy. Int J Radiat Oncol Biol Phys 59:1080

    Article  PubMed  Google Scholar 

  25. Ho A, Cordeiro P, Disa J et al (2012) Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation. Cancer 118:2552–2559

    Article  PubMed  Google Scholar 

  26. Bashnagel AM, Shah C, Wilkinson JB et al (2012) Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after post-mastectomy radiation. Clin Breast Cancer 22:248–432

    Google Scholar 

  27. Cowen D, Gross E, Rouannet P et al (2010) Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications. Breast Cancer Res Treat 121:627–634

    Article  PubMed  Google Scholar 

  28. Pestana IA, Campbell DC, Bharti G et al (2013) Factors affecting complications in radiated breast reconstruction. Ann plast Surg 70:542–545

    Article  CAS  PubMed  Google Scholar 

  29. Nguyen KT, Hanwright PJ, Smetona JT, Hirsch EM, Seth AK, Kim JY (2014) Body mass index as a continuous predictor of outcomes after expander-implant breast reconstruction. Ann Plast Surg 73:19–24

    Article  CAS  PubMed  Google Scholar 

  30. Poortmans PM, Collette S, Kirkove C et al (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373:317–327

    Article  CAS  PubMed  Google Scholar 

  31. Spear SL, Seruya M, Rao SS et al (2012) Two-stage prosthetic breast reconstruction using alloderm including outcomes of different timings of radiotherapy. Plast Reconstr Surg 130:1–9

    Article  CAS  PubMed  Google Scholar 

  32. Ho AL, Bovill ES, Macadam SA, Tyldesley S, Giang J, Lennox PA (2014) Postmastecomy radiation therapy after immediate two-stage tissue expander/implant breast reconstruction: a University of British Columbia perspective. Plast Reconstr Surg 134:1–10

    Article  Google Scholar 

  33. Ribuffo D, Atenzi M, Guerra M, Bucher S, Politi C, Deidda M, Atzori F, Dessi M, Mededdu C, Lay G (2013) Treatment of irradiated expanders: protective lipofilling allows immediate prosthetic breast reconstruction in the setting of postoperative radiotherapy. Aesthet Plast Surg 37:1146–1152

    Article  Google Scholar 

  34. Mizuno H, Hyakusoku H (2014) Fat grafting supplemented by adipose-derived stem cells for breast augmentation. In: Shiffman MA, DiGiuseppe A (eds) Stem cells in aesthetic procedures. Springer, Berlin, pp 557–562

    Google Scholar 

  35. Spear SL, Baker JL (1995) Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 96:1119–1123

    Article  CAS  PubMed  Google Scholar 

  36. Pierce LJ, Strawderman M, Narod SA et al (2000) Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA 1/2 mutations. J Clin Oncol 18:3360–3369

    Article  CAS  PubMed  Google Scholar 

  37. Shanley S, McReynolds K, Ardern-Jones A et al (2006) Late toxicity is not increased in BRCA1/BRCA2 mutation carriers undergoing breast radiotherapy in the United Kingdom. Clin Cancer Res 12:7025–7032

    Article  CAS  PubMed  Google Scholar 

  38. Gaffney DK, Brohet RM, Lwis CM et al (1998) Response to radiation therapy and prognosis in breast cancer patients with BRCA1 and BRCA2 mutations. Radiother Oncol 47:129–136

    Article  CAS  PubMed  Google Scholar 

  39. Anderson PR, Freedman G, Nicolaou N et al. (2009) Postmastecomy chest wall radiation to a temporary tissue expander or permanent breast implant—is there a difference in complication rates? Int J Radiati Oncol Biol Phys 74:81–85

    Article  Google Scholar 

  40. Loprinzi CL, Barton CL, Qin R (2011) Nonestrogenic management of hot flashes. J Clin Oncol 29:3842–3844

    Article  PubMed  Google Scholar 

  41. Boekhout AH, Vincent AD, Dalesio OB et al (2011) Management of hot flashes in patients who have breast cancer with venlaxifine and clonidine: a randomized double-blind placebo controlled trial. J Clin Oncol 29:3862–3868

    Article  CAS  PubMed  Google Scholar 

  42. Stearns V, Slack R, Greeop N et al (2005) Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol 23:6919–6930

    Article  CAS  PubMed  Google Scholar 

  43. Loprinzi CL, Sloan J, Stearns V et al (2009) Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol 27:2831–2837

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Haque R, Shi J, Schottinger JE, Ahmed SA, Cheetham TC (2015) Tamoxifen and antidepressant drug interaction in a cohort of 16,887 breast cancer survivors. J Natl Cancer Inst 108:1–8

    Google Scholar 

  45. Andrade C (2014) Antidepressant augmentation with anti-inflammatory agents. J Clin Psychiatry 75:957–977

    Article  Google Scholar 

  46. Shin J-Y, Park M-J, Lee SH, Choi S-H, Kim M-H, Choi N-K, Lee J, Park B-J (2015) Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ 351:1–7

    Google Scholar 

  47. Glaser K et al (2011) Impact of psychological stress on wound healing. Immunol Allergy Clin N Am 31:81–89

    Article  Google Scholar 

  48. Baek S-H (2014) Identification and preoperative optimization of risk factors to prevent periprosthetic joint infection. World J Orthop 5:362–367

    Article  PubMed  PubMed Central  Google Scholar 

  49. Low CA, Bovbjerg DH, Ahrendt S, Alhelo S, Choudry H et al (2016) Depressive symptoms in patients scheduled for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: prospective associations with morbidity and mortality. J Clin Oncol 34:1217–1222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Theodore D (2014) Depression linked to postop infection. 54th interscience conference on antimicrobial agents and chemotherapy Medscape September 08, 2014

  51. DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effect of anxiety and depression on patient adherence. Arch Int Med 160:2102–2107

    Article  Google Scholar 

  52. Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and unfavourable effects on long-term survival off radiotherapy for early breast cancer: an overview of the randomized trials. Lancet 355:1757–1770

    Article  Google Scholar 

  53. Wang F, Peled AW, Chin R, Fowble B, Alvarado M, Ewing C, Esserman L, Foster R, Sbitany H (2016) The impact of radiation therapy, lymph node dissection, and hormonal therapy on outcomes of tissue expander-implant exchange in prosthetic breast reconstruction. Plast Reconstr Surg 137:1–9

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of Radiation Oncology, St. John Macomb Oakland Hospital Webber Cancer Center, 11800 E 12 Mile Rd, Warren, MI, 48093, USA

    Paul J. Chuba, Rachael Wagner, Anna Rabbani, Cynthia H. Browne & Amr Aref

  2. Renaissance Plastic Surgery, Troy, MI, 48083, USA

    William A. Stefani

  3. Great Lakes Cancer Management, Macomb, MI, 48044, USA

    Carrie Dul

  4. Department of Graduate Medical Education, St. John Hospital and Medical Center, Detroit, MI, 48236, USA

    Susan Szpunar

  5. Michigan Breast Specialists, Grosse Pointe, MI, 48236, USA

    Jeffrey Falk

  6. Department of Surgery, St John Hospital and Medical Center, Detroit, MI, 48236, USA

    Elango Edhayan

  7. St. John Hospital and Medical Center Van Elslander Cancer Center, Grosse Pointe, MI, 48236, USA

    Paul J. Chuba, Anna Rabbani, Cynthia H. Browne & Amr Aref

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  1. Paul J. Chuba
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  2. William A. Stefani
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Correspondence to Paul J. Chuba.

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Chuba, P.J., Stefani, W.A., Dul, C. et al. Radiation and depression associated with complications of tissue expander reconstruction. Breast Cancer Res Treat 164, 641–647 (2017). https://doi.org/10.1007/s10549-017-4277-6

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  • DOI: https://doi.org/10.1007/s10549-017-4277-6

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