Background: Although the effects of postoperative radiation on tissue expander breast reconstruction are well documented, few data exist regarding the effects of prereconstruction radiation. This study evaluates the outcomes of tissue expander breast reconstruction in women with prereconstruction radiation. Methods: This study retrospectively evaluated two treatments: (1) mastectomy without reconstruction followed by postoperative radiation and delayed reconstruction (10 patients) and (2) failed breast-conserving therapy (lumpectomy plus radiotherapy) necessitating mastectomy and immediate reconstruction (66 patients). Procedures were performed at Northwestern Memorial Hospital between August of 1999 and July of 2008. Average follow-up was 35 months. Results: In both groups, approximately 60 percent of patients successfully completed two stages of reconstruction. Overall complication rates, including major and minor complications, were 70 percent per reconstruction (37 percent first stage, 45 percent second stage) for immediate reconstruction and 50 percent per reconstruction (20 percent first stage, 38 percent second stage) for delayed reconstruction. No differences in complication rates were observed based on age, smoking status, body mass index, or timing between radiation and surgery (p > 0.05). Conclusions: When discussing expander/implant reconstruction with patients who have a history of prior breast radiotherapy, a frank discussion of the risks, benefits, and alternatives should occur. If a 40 percent total explantation or conversion to flap rate is truly understood by the patient, and if immediate autologous breast reconstruction is to be avoided, then the patient may proceed with tissue expander breast reconstruction. For patients who wish to avoid additional scars or more invasive procedures, however, this study demonstrates that they have a 60 percent chance of success.
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