NEW ORLEANSPatients undergoing staged breast reconstruction
with saline-filled implants and subsequent radiation therapy
experienced more complications and required more replacement
procedures than patients who underwent reconstruction without
radiation therapy, according to a retrospective study presented at
the 68th Annual Scientific Meeting of the American Society of Plastic
and Reconstructive Surgeons (now the American Society of Plastic Surgeons).
With the number of patients undergoing radiation therapy for breast
cancer increasing dramatically, there is a need for outcome
information for staged saline implant reconstruction in irradiated
breasts, said Scott Spear, MD, professor and chief, Division of
Plastic Surgery, Georgetown University Medical Center.
The investigators retrospectively reviewed 40 consecutive patients
who had undergone two-stage saline-filled implant breast
reconstruction and radiation therapy between 1990 and 1997.
Most of the group (19 patients) had undergone mastectomy and adjuvant
radiation therapy during reconstruction and expansion. Seven patients
had undergone previous lumpectomy and radiation therapy; nine
patients had mastectomy with radiation therapy before reconstruction,
and five patients had radiation therapy after reconstruction.
The control group comprised 40 randomly selected patients who had
undergone two-stage saline-filled implant breast reconstructions
after radiation therapy.
A total of 32.5% of the patients with irradiated implants experienced
capsular contracture and 12.5% experienced infections that required
antibiotic treatment. Other complications in the irradiated group
included actual extrusion in two patients and threatened extrusion
that was salvaged in one patient. The control group experienced two
threatened extrusions that were salvaged and two deflations.
Nearly half (47.5%) of the 40 irradiated breasts containing saline
implants ultimately needed the addition of, or replacement by, a
latissimus dorsi flap. In comparison, only 10% of the 40 patients in
the control group with nonirradiated saline implant reconstructions
required addition of a flap, and none required replacements.
Latissimus dorsi flaps after radiation therapy have proved to be an
excellent solution to the problem of postradiation tissue
contracture, which can occur during breast expander reconstruction.
But, according to Dr. Spear, it is unwise to use the procedure before
or with radiation therapy.
Reconstructions are more complicated in patients who have had
radiation. More often than not, an implant alone wont be
satisfactory, Dr. Spear said in an interview after the meeting.
Therefore, he emphasized, it is important to considerprior to
mastectomywhether radiation therapy will be necessary, so that
the most optimal method of reconstruction can be planned.