Radiotherapy Increases Major Complications and Complication-related Reconstruction Failures in Patients with Implant-based Breast Reconstruction

Abstract

\n Purpose This study was designed to assess the impact of post-mastectomy radiation therapy (PMRT) on reconstruction complications and failures in patients undergoing mastectomy and different types of breast reconstruction.Methods We retrospectively identified 832 breast cancer patients who underwent mastectomy and breast reconstruction at Fudan University Shanghai Cancer Center between June 2001 and December 2015. Of these, 159 patients received PMRT, and 673 patients did not receive PMRT. The endpoints of the reconstruction outcomes included any complications, major complications, overall reconstruction failures and complication-related reconstruction failures. Multivariate analysis was applied to identify independent predictors of reconstruction outcomes in patients with different types of breast reconstruction. The nomogram model was built on the basis of the multivariate analysis to predict complication-related reconstruction failures.Results The median follow-up time was 58.5 months. Of all 832 patients, 394 patients received implant-based reconstruction, and 438 patients received autologous reconstruction. For patients with implant-based reconstruction, multivariate analysis showed that PMRT was associated with 3.16 times (95% CI 1.17-8.54, p=0.023) higher odds of major complications and 3.22 times (95% CI 1.01-10.20, p=0.047) higher odds of complication-related reconstruction failures but was not associated with any complications (OR 1.73, 95% CI 0.88-3.38, p=0.113) or overall reconstruction failures (OR 2.09, 95% CI 0.76-5.73, p=0.152). The nomogram model for implant-based reconstruction showed good predictive performance for complication-related reconstruction failures (AUC =0.714).Conclusions PMRT appears to be associated with an increased risk of major complications and complication-related reconstruction failures in patients with implant-based reconstruction.