By John Otrompke
CHICAGO -- November 9, 2009 -- Patients with breast cancer who receive breast reconstruction surgery following radiation therapy experience more complications, researchers stated here at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting.
In the study, 118 women underwent mastectomy and reconstruction at Beth Israel Deaconess Hospital, Boston, Massachusetts, between 1999 and 2006. The women also received postmastectomy radiotherapy of which 57 had radiation first, and 56 had reconstruction first.
Of those who received radiation first, 32% had complications, compared with 45% of those who had reconstruction first.
However, early complications (those occur in within 90 days of radiation therapy) were 18% for those women who had radiation first, compared with 11% of those who had reconstruction first.
On the other hand, only 14% of those who had radiation first had late complications, compared with 34% of those who had reconstruction first.
"For example, capsular contracture, which occurs when the breast shrinks because fibrosis occurs around the implant, was more common in the group that had breast reconstruction first," said Tolulope A. Adesiyun, Harvard Medical School, Boston, Massachusetts, who presented the study on November 3. "If we do the reconstruction first, and then we irradiate it, maybe the radiation caused some fibrosis."
However, satisfaction rates did not differ significantly between the 2 groups, Adesiyun said. "Even if the patient had a capsular contracture, it was possibly that the patient might still be just as satisfied, once they had it fixed," she said.
Those women who received the breast reconstruction prior to irradiation got the reconstruction surgery at the same time they had a mastectomy. "The breast surgeon performs the mastectomy, then a plastic surgeon performs the breast reconstruction surgery," said Adesiyun.
The overall complication rate, for both groups, was 29% in those women who had autologous reconstruction surgery, compared with 43% of those who had autologous reconstruction surgery with an implant. Those who received an implant or tissue expander only experienced a 71% complication rate, with most of the complications being capsular contractures.
[Presentation title: Impact of Sequencing of Postmastectomy Radiotherapy and Breast Reconstruction on Timing and Rate of Complications and Patient Satisfaction. Abstract 108]
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