Outcomes of Immediate Implant-Based Mastectomy Reconstruction in Women with Previous Breast Radiation.

BACKGROUND: The objective was to determine if women with history of radiation prior to mastectomy experience similar risk for postoperative complications and patient reported outcomes to women undergoing post mastectomy radiation therapy in the setting of immediate implant reconstruction. METHODS: The cohort included patients undergoing immediate implant reconstruction at 11 centers across North America. Women were categorized into three groups: prior breast conservation therapy, post mastectomy radiation therapy, and no radiation therapy. Mixed effect logistic regressions were used to analyze the effects of radiation status on complication rates and patient-reported outcomes. RESULTS: 1594 patients were analyzed, including 84 women with prior breast conservation therapy, 329 women who underwent post mastectomy radiation therapy, and 1,181 women with no history of radiation. Compared with post-mastectomy radiation, breast conservation was associated with lower rates of all complications and major complications (OR 0.65, 95% CI 0.37-1.14, p=0.13; OR 0.61, 95% CI 0.33-1.13, p=0.12). These differences were not statistically significant. Rates of reconstructive failure between the two cohorts were comparable. Prior to reconstruction, satisfaction with breast was lowest for women with prior breast conservation therapy (p<.001). At two years post-operatively, satisfaction with breast was lower for women with post mastectomy radiation, compared with breast conservation patients (p=0.007). CONCLUSIONS: Higher postoperative complication rates were observed in women exposed to radiation regardless of timing. Though women with prior breast conservation experienced greater satisfaction with their breasts and fewer complications when compared to women undergoing post mastectomy radiation, there was a similar risk for reconstruction failure.