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The Impact of Radiotherapy on Reoperation Rates in Patients Undergoing Mastectomy and Breast Reconstruction

  • Li Zhang
  • Kairui Jin
  • Xuanyi Wang
  • Zhaozhi Yang
  • Junqi Wang
  • Jinli Ma
  • Xin Mei
  • Xingxing Chen
  • Xiaofang Wang
  • Zhirui Zhou
  • Jurui Luo
  • Jiong Wu
  • Zhimin Shao
  • Zhen Zhang
  • Xiaoli YuEmail author
  • Xiaomao GuoEmail author
Breast Oncology
  • 32 Downloads

Abstract

Objective

The aim of this study was to determine the impact of postmastectomy radiotherapy (PMRT) on reoperation rates in women with breast cancer undergoing mastectomy and breast reconstruction.

Methods

Between June 2001 and December 2015, 832 breast cancer patients treated with mastectomy and breast reconstruction with (n = 159) or without (n = 673) PMRT were analyzed retrospectively. Reoperations following breast reconstruction were categorized into the following three types: anticipated, unanticipated, and others. Multivariable logistic regression models were used to evaluate the impact of PMRT on overall and unanticipated reoperations according to different breast reconstruction types after adjusting for relevant covariates.

Results

With a median follow-up of 58.5 months, a total of 1298 operations were performed in 832 breast cancer patients. The rates of overall and unanticipated reoperations were 46.2% and 7.7%, respectively. Multivariable analysis showed that PMRT was not associated with overall reoperations in either implant-based reconstruction patients (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.43–2.37, p = 0.995) or autologous reconstruction patients (OR 0.85, 95% CI 0.52–1.40, p = 0.533); however, the impact of PMRT on unanticipated reoperations differed by reconstruction type. In patients who received implant-based reconstructions, PMRT was associated with a 3.05-fold (95% CI 1.20–7.75, p = 0.019) higher odds of unanticipated reoperations, while there was no difference in patients who underwent autologous reconstruction (OR 1.17, 95% CI 0.51–2.66, p = 0.713). Delayed reconstruction or delayed–immediate reconstructions were associated with an increased risk of both overall and unanticipated reoperations in both reconstruction cohorts.

Conclusions

PMRT appears to be associated with an increased risk of unanticipated reoperations among patients receiving implant-based reconstruction, but not among those receiving autologous reconstruction. The risk of reoperation should be taken into consideration when selecting the appropriate breast reconstruction type when PMRT is planned.

Notes

Disclosures

None.

References

  1. 1.
    Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9–16.CrossRefGoogle Scholar
  2. 2.
    Eltahir Y, Werners LL, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2013;132(2):201e-209e.CrossRefGoogle Scholar
  3. 3.
    Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32(9):919–926.CrossRefGoogle Scholar
  4. 4.
    Jia-jian C, Nai-si H, Jing-yan X, et al. Current Status of Breast Reconstruction in Southern China: A 15 Year, Single Institutional Experience of 20,551 Breast Cancer Patients. Medicine. 2015;94(34):e1399.CrossRefGoogle Scholar
  5. 5.
    Roberts A, Baxter N, Camacho X, Lau C, Zhong T. Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction. Ann Surg Oncol. 2015;22(10):3302–3307.CrossRefGoogle Scholar
  6. 6.
    Boughey JC, Hoskin TL, Hartmann LC, et al. Impact of reconstruction and reoperation on long-term patient-reported satisfaction after contralateral prophylactic mastectomy. Ann Surg Oncol. 2015;22(2):401–408.CrossRefGoogle Scholar
  7. 7.
    McGale P, Taylor C, Correa C, et al. 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.CrossRefGoogle Scholar
  8. 8.
    Jagsi R, Momoh AO, Qi J, et al. Impact of Radiotherapy on Complications and Patient-Reported Outcomes After Breast Reconstruction. J Natl Cancer Inst. 2018;110(2).Google Scholar
  9. 9.
    Barry M, Kell MR. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat. 2011;127(1):15–22.CrossRefGoogle Scholar
  10. 10.
    Momoh AO, Ahmed R, Kelley BP, et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol. 2014;21(1):118–124.CrossRefGoogle Scholar
  11. 11.
    Berbers J, van Baardwijk A, Houben R, et al. ‘Reconstruction: before or after postmastectomy radiotherapy?’ A systematic review of the literature. Eur J Cancer. 2014;50(16):2752–2762.CrossRefGoogle Scholar
  12. 12.
    Hvilsom GB, Holmich LR, Steding-Jessen M, et al. Delayed breast implant reconstruction: is radiation therapy associated with capsular contracture or reoperations? Ann Plast Surg. 2012;68(3):246–252.CrossRefGoogle Scholar
  13. 13.
    Rusby JE, Waters RA, Nightingale PG, England DW. Immediate breast reconstruction after mastectomy: what are the long-term prospects? Ann R Coll Surg Engl. 2010;92(3):193–197.CrossRefGoogle Scholar
  14. 14.
    Zion SM, Slezak JM, Sellers TA, et al. Reoperations after prophylactic mastectomy with or without implant reconstruction. Cancer. 2003;98(10):2152–2160.CrossRefGoogle Scholar
  15. 15.
    Eom JS, Kobayashi MR, Paydar K, Wirth GA, Evans GR. The number of operations required for completing breast reconstruction. Plast Reconstr Surg Glob Open. 2014;2(10):e242.CrossRefGoogle Scholar
  16. 16.
    Al-Hilli Z, Thomsen KM, Habermann EB, Jakub JW, Boughey JC. Reoperation for Complications after Lumpectomy and Mastectomy for Breast Cancer from the 2012 National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg Oncol. 2015;22 Suppl 3:S459–469.CrossRefGoogle Scholar
  17. 17.
    Venkat R, Lee JC, Rad AN, Manahan MA, Rosson GD. Bilateral autologous breast reconstruction with deep inferior epigastric artery perforator flaps: Review of a single surgeon’s early experience. Microsurgery. 2012;32(4):275–280.CrossRefGoogle Scholar
  18. 18.
    Cordeiro PG, McGuire P, Murphy DK. Natrelle 410 Extra-Full Projection Silicone Breast Implants: 2-Year Results from Two Prospective Studies. Plast Reconstr Surg. 2015;136(4):638–646.CrossRefGoogle Scholar
  19. 19.
    Sue GR, Sun BJ, Lee GK. Complications After Two-Stage Expander Implant Breast Reconstruction Requiring Reoperation: A Critical Analysis of Outcomes. Ann Plast Surg. 2018;80(5S Suppl 5):S292–S294.Google Scholar
  20. 20.
    Eriksson M, Anveden L, Celebioglu F, et al. Radiotherapy in implant-based immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat. 2013;142(3):591–601.CrossRefGoogle Scholar
  21. 21.
    Unukovych D, Sandelin K, Wickman M, et al. Breast reconstruction in patients with personal and family history of breast cancer undergoing contralateral prophylactic mastectomy, a 10-year experience. Acta Oncol. 2012;51(7):934–941.CrossRefGoogle Scholar
  22. 22.
    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(6):633–640.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Li Zhang
    • 1
    • 2
  • Kairui Jin
    • 1
    • 2
  • Xuanyi Wang
    • 1
    • 2
  • Zhaozhi Yang
    • 1
    • 2
  • Junqi Wang
    • 1
    • 2
  • Jinli Ma
    • 1
    • 2
    • 3
  • Xin Mei
    • 1
    • 2
  • Xingxing Chen
    • 1
    • 2
  • Xiaofang Wang
    • 1
    • 2
  • Zhirui Zhou
    • 1
    • 2
  • Jurui Luo
    • 1
    • 2
  • Jiong Wu
    • 2
    • 3
  • Zhimin Shao
    • 2
    • 3
  • Zhen Zhang
    • 1
    • 2
  • Xiaoli Yu
    • 1
    • 2
    Email author
  • Xiaomao Guo
    • 1
    • 2
    Email author
  1. 1.Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
  3. 3.Department of Breast SurgeryFudan University Shanghai Cancer CenterShanghaiChina

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