Breast Reconstruction Complications After Postmastectomy Proton Radiation Therapy for Breast Cancer
Breast Reconstruction Complications After Postmastectomy Proton Radiation Therapy for Breast Cancer
Blog Article
Purpose: Our purpose was to report complications requiring surgical intervention among patients treated with postmastectomy proton radiation therapy (PMPRT) for breast cancer in the setting of breast reconstruction (BR).Methods and Materials: Patients enrolled on a prospective proton registry who underwent BR with immediate autologous flap, tissue expander (TE), or implant in place during PMPRT (50/50.4 Gy +/- chest wall boost) were eligible.Major reconstruction complication (MRC) was defined as a complication requiring surgical intervention.
Absolute reconstruction failure was an MRC requiring surgical Door Corner Cap removal of BR.A routine revision (RR) was a plastic surgery refining cosmesis of the BR.Kaplan-Meier method was used to assess disease outcomes and MRC.Cox regression was used to assess predictors of MRC.
Results: Seventy-three courses of PMPRT were delivered to 68 women with BR between 2013 and 2021.Median follow-up was 42.1 months.Median age was 47 years.
Fifty-six (76.7%) courses used pencil beam scanning PMPRT.Of 73 BR, 29 were flaps (39.7%), 30 implants (41.
1%), and 14 TE (19.2%) at time of irradiation.There were 20 (27.4%) RR.
There were 9 (12.3%) MRC among 5 implants, 2 flaps, and 2 TE, occurring a median of 29 months from PMPRT start.Three-year freedom from MRC was 86.9%.
Three (4.1%) of the MRC were absolute reconstruction failure.Complications leading to MRC included capsular contracture in 5, fat necrosis in 2, and infection in 2.On univariable analysis, BR M Shorts type, boost, proton technique, age, and smoking status were not associated with MRC, whereas higher body mass index trended toward significance (hazard ratio, 1.
07; 95% CI, 0.99-1.16; P =.10).
Conclusions: Patients undergoing PMPRT to BR had a 12.3% incidence of major complications leading to surgical intervention, and total loss of BR was rare.MRC rates were similar among reconstruction types.Minor surgery for RR is common in our practice.