Abstract P4-17-08: Tissue Expander/Implant Breast Reconstruction with and without Postmastectomy Radiation: Predictive Factors for Complications

Purpose: 1) Review our complication rates with implant/expander reconstruction for breast cancer 2) Determine factors for complications, especially with postmastectomy radiation (PMRT) Materials and Methods: Data were collected through chart review of all patients (2004–2008) from an academic hospital undergoing implant/expander reconstruction. SAS was used for two or multi-variable analyses (logistic regression) to determine predictive factors for complications. Among PMRT patients, we evaluated complications rates by risk factors. Results: 237 patients underwent implant/expander reconstruction. Median time from implant placement until last follow-up was 173 days. 21.5% developed major complications (needing operative time or infection needing intravenous treatment). Diabetes was the most consistent factor associated with major complications (46.7 vs 20.1%, p = 0.02 and p = 0.009 in multivariable analysis). Radiation was linked to capsular contractures (18.6 vs 10.1%, p = 0.02). Chemotherapy (25.0 vs 19.0%, p = 0.26) or radiation (26.3 vs 19.1%, p = 0.21) did not predict major complications. Among patients receiving PMRT (80 patients), 26.2% had major complications, 34 had immediate PMRT on the expander and 44 had PMRT to the chest wall, followed by delayed reconstruction with expander/implant placement. In these, delayed reconstruction increased dehiscence (0 vs 18.2%, p = 0.009) compared to immediate reconstruction, with a trend for higher incidence of major complications in the delayed reconstruction group (14.7 vs 34.1%, p = 0.05). 40 Gy/16 versus 50–50.4 Gy/25-28 (28 vs 24%, p = 0.78) was not associated with major complications. Diabetes and smoking were associated with several complications. Conclusions: Diabetes is associated with a higher rate of major complications after expander/implant reconstruction while radiation increases capsular contractures. If PMRT is indicated, putting in an expander before radiation results in less morbidity than delayed reconstruction. Also, 40 Gy/16 versus 50–50.4 Gy/25-28 do not differ much in terms of complication rates. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-17-08.