Abstract P2-13-02: Radiation and depression associated with complications of tissue expander reconstruction
Authors: Wagner RM , Spzunar SM , Stefani WA , Falk JS , Williams JL , Edhayan E , Dul CL , Rodriguez D , Busuito MJ , Browne CH , Aref A , Rabbani AN , Chuba PJ 
Published: May 2016

Abstract
Background: Rates of implant failure, wound healing delay, and infection are higher in patients having RT after tissue expander (TE) and permanent implant reconstruction. Some have suggested greater complications with increased body mass index (BMI) and with diabetes.
Patients and Methods: 127 patients had bilateral TE reconstruction and radiation from 2003 to 2013 at two centers. In 95% (121/127) of cases RT was performed while the TE was in place with the permanent implant inserted after RT. 3D-CRT technique included 50 Gy with daily or every other day bolus and forward planned segments. The supraclavicular and/or internal mammary lymph node bearing regions were treated in 82.7% (105/127) cases. The non-irradiated breast provided an internal control. Chi-squared testing of pretreatment factors included radiation, chemotherapy, and medical history of hypertension, diabetes, cardiovascular, and pulmonary disease. BMI, tobacco and alcohol use, use of antiestrogen, statin, antidepressant, antihypertensive, anxiolytics, and antidiabetic medications were also studied. Comparison of differences in means for continuous variables used analysis of variance, then multiple pairwise comparisons with Bonferroni correction of p-value.
Results: Mean age was 53 ± 10.1 years with just 14.6% African- American. Twelve (9.4%) were BRCA positive (9 BRCA1, 4 BRCA2, 1 Both). Nearly all complications were in the radiated breast. Complications were: Grade 0 (no complication; 43.9%), Grade 1 (tightness and/or drifting of implant or Baker grade II capsular contracture; 30.9 %), Grade 2 (infection, hypertrophic scarring, or incisional necrosis; 9.8%), Grade 3 (Baker grade III capsular contracture, wound dehiscence, or impending exposure of implant; 5.7%), Grade 4 (implant failure, exchange of implant, or Baker grade IV capsular contracture; 9.8%). 15.3 percent (19 cases) experienced grade 3 or 4 complication and 9.8% (12 cases) had grade 4 complication. Considering non-irradiated breasts, there were two (1.6%) Grade 3-4 complications. For BMI, there was no significant difference by category as defined by the CDC (p=0.91). Patients history of HRT tended to be more likely to have Grade 3 or 4 complications (31.8% vs 12.4% respectively; p=0.08). Patients with depression were more likely to experience a Grade 3 or 4 complication (29.4% vs 13.2%; p=0.01). Multiple logistic regression was used to predict the probability of a Grade 3 or 4 complication with HR use and depression as independent variables. Patients with depression were 4.2 times more likely to have a Grade 3 or 4 complication (OR=4.2, p=0.03) and patients with a history of HRT use were 3.4 times more likely to experience a Grade 3 or 4 complication (OR = 3.4, p=0.04). Only clinical diagnosis of depression was considered as 12/31 (38.7%) with antidepressants used only venlafaxine. Neither BRCA status (p=0.72) nor chemotherapy factors (p=0.42) were associated with complication rates.
Conclusions: Higher rates of TE reconstruction complications may be expected in patients receiving radiotherapy. Patients reporting medical history of depression or HRT use showed statistically significant increase in complication rates. This effect might be attributed to a drug effect or to patient factors such as body image.
Citation Format: Wagner RM, Spzunar SM, Stefani WA, Falk JS, Williams JL, Edhayan E, Dul CL, Rodriguez D, Busuito MJ, Browne CH, Aref A, Rabbani AN, Chuba PJ. Radiation and depression associated with complications of tissue expander reconstruction. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-13-02.