The Impact of Radiation and Chemotherapy on Outcomes in Patients Who Complete Implant-Based Breast Reconstruction
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INTRODUCTION: Treatments for breast cancer include neoadjuvant chemotherapy (NACT), adjuvant chemotherapy (ACT), radiation (RAD), and combinations of these therapies. Many of these patients will choose to pursue implant-based breast reconstruction concurrently with these treatments. Effects of these therapies on the outcomes of implant-based reconstructions have not been studied fully. METHODS: From January 2012 to December 2016 two surgeons performed 542 breast reconstructions using tissue expanders (TE). The number of patients choosing implants who completed reconstruction was n=272. They were split into 8 groups based on therapy received: Group 1 (no treatment, n=139), Group 2 (NACT, n=32), Group 3 (ACT, n=44), Group 4 (NACT+ACT, n=14), Group 5 (NACT+RAD, n=17), Group 6 (ACT+RAD, n=13), Group 7 (RAD, n=12), Group 8 (ACT+NACT+RAD, n=1). Group 8 was excluded because it had only one patient, leaving n=271. ANOVA (df between groups = 6, df within groups = 264) and Tukey HSD were run to compare differences in the percentages of patients with infections requiring IV antibiotics, necrosis requiring operation, seroma, and TE exchange for new TE. Numbers of different surgeries were also counted. RESULTS: Comorbidities and age were equivalent across groups, except for Group 7 (55.7 yr) and Group 4 (41.6 yr), p=.03. There were no significant differences in percentages of patients with infection requiring IV antibiotics (p=.32), necrosis requiring operation (p=.09), or seroma (p=.40). For patients who required replacement of TE with another TE due to complication, only Group 1 (1.4%) vs Group 6 (15.4%) had a significant difference, p=.04. There were no differences in the mean numbers of complication-related surgeries before implant placement (p=.07), complication-related surgeries after implant placement (p=.30), revision surgeries (p=.98), or total surgeries (p=.29). There were no significant differences in the percentages of patients receiving at least one complication-related surgery before implant (p=.16), at least one complication-related surgery after implant (p=.85), or at least one revision surgery (p=.94). CONCLUSION: Among most patients who choose to undergo implant-based reconstruction in an academic practice, we found no significant differences in complication rates, mean numbers of surgeries per patient, and percentages of patients undergoing different types of surgeries. Although patients with combined adjuvant chemotherapy and radiation had a higher rate of TE exchange for new TE due to complication, the rates of other complications and surgeries were comparable. Given these results, practice trends in breast reconstruction can remain cautiously optimistic for patients choosing implant-based reconstruction concurrently with cancer treatments.
The 56th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 23, 2018, 2-5 p.m., D1.600)
Combined Modality Therapy
Tissue Expansion Devices
Jayaraman, A., Hampton, S. N., Nair, L. A., Venutolo, C., Haddock, N. T., & Teotia, S. S. (2018, January 23). The impact of radiation and chemotherapy on outcomes in patients who complete implant-based breast reconstruction. Poster presented at the 56th Annual Medical Student Research Forum, Dallas, TX. Retrieved from https://hdl.handle.net/2152.5/5345