breast reconstructioin using tissue expanders & implants: unfavorable

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Ann Plast Surg 1998 Apr;40(4):360-363

Breast reconstruction in previously irradiated patients using tissue

expanders and implants: a potentially unfavorable result.

Forman DL, Chiu J, Restifo RJ, Ward BA, Haffty B, Ariyan S

Section of Plastic Surgery, Yale University School of Medicine, New

Haven, CT, USA.

There exists a paucity of definitive information on the suitability

of implant reconstructions in previously irradiated breast cancer

patients. This controversial topic prompted a review of our

prosthetic reconstructions in this select group of patients. A

retrospective study of patients treated between 1976 and 1993 with

lumpectomy and radiation therapy for early breast cancer revealed 67

patients with local recurrences. Nine of these patients (10 breasts)

underwent a two-stage prosthetic reconstruction following a salvage

mastectomy. The average age was 47.9 years. The mean dose of

irradiation was 6,070 cGy. The average interval from radiation

therapy to placement of a tissue expander was 4.6 years. In one

patient (10%) the tissue expander extruded. The average follow-up

for 8 patients (9 breasts) who underwent exchange to a permanent

prosthesis was 5.1 years. In four reconstructions (40%) there was an

uneventful postoperative course. Two cases (20%) were difficult to

expand and the final result lacked projection. One patient (10%)

developed an infection requiring removal of the permanent

prosthesis. Two patients (20%) developed Baker class III or IV

capsular contractures. Overall, in our group of 10 implant

reconstructions, 60% of the patients resulted in either a

complication or an unfavorable result.

PMID: 9555989, UI: 98215275