Abstract P2-14-01: Immediate implant-based breast reconstruction following total skin-sparing mastectomy: Defining the risk of preoperative and postoperative radiation therapy on surgical outcomes
Authors: Warren Peled Anne , Wang Frederick , Foster Robert D , Lentz Rachel , Alvarado Michael , Ewing Cheryl A , Esserman Laura J , Fowble Barbara , Sbitany Hani 
Published: May 2015

Abstract
Background
Radiation therapy is an increasingly common adjuvant treatment in breast cancer therapy. As total skin-sparing mastectomy (TSSM) and immediate reconstruction becomes more widely performed, further defining the risks of various treatment regimens on surgical and reconstructive outcomes after TSSM is important. In this study, we assess the effects of premastectomy and postmastectomy radiation therapy on outcomes following TSSM and immediate prosthetic reconstruction.
Methods
All patients undergoing TSSM and immediate tissue expander/implant reconstruction at our institution between 2006 and 2012 were identified from a prospectively maintained database. Cohort 1 included patients undergoing TSSM and reconstruction without any radiation. Cohort 2 included patients with a prior history of radiation before TSSM and reconstruction. Cohort 3 included patients undergoing radiation after TSSM and reconstruction. Complication rates were compared between cohorts.
Results
A total of 580 patients were identified undergoing 903 breast reconstructions following TSSM. Cohort 1 included 727 breasts, cohort 2 included 63 breasts, and cohort 3 included 113 breasts. Compared to patients without radiation, patients with prior radiation were more likely to develop severe infection (7.3% vs. 20.6%, p = 0.001), incisional breakdown (3.1% vs. 9.5%, p = 0.01), and expander/implant loss (5.1% vs. 20.6%, p &lt; 0.0001). Similarly, patients with postmastectomy radiation had higher rates of severe infection (22.1%, p &lt; 0.0001) and expander/implant loss (17.7%, p &lt; 0.0001) compared to patients without radiation, though equivalent rates of incisional breakdown (6.1%, p = 0.57). All three cohorts showed similar low rates of partial or complete nipple-areolar complex necrosis (1.2% vs. 3.2% vs. 0%, respectively).
Conclusions
Both preoperative and postoperative radiation following TSSM and immediate prosthetic reconstruction result in higher, but acceptable, complication risks. Risks of infection and expander/implant loss in irradiated patients who have undergone TSSM are similar to those reported after skin-sparing mastectomy. Further, the low rates of complications related to nipple-areolar complex skin preservation in irradiated patients are equivalent to those seen in non-irradiated patients, supporting the safety of performing TSSM in patients who require radiation therapy.
Citation Format: Anne Warren Peled, Frederick Wang, Robert D Foster, Rachel Lentz, Michael Alvarado, Cheryl A Ewing, Laura J Esserman, Barbara Fowble, Hani Sbitany. Immediate implant-based breast reconstruction following total skin-sparing mastectomy: Defining the risk of preoperative and postoperative radiation therapy on surgical outcomes [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-14-01.