Patient-Reported Outcomes after Irradiation of Tissue Expander versus Permanent Implant in Breast Reconstruction: A Multicenter Prospective Study
- 1 May 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 145 (5), 917e-926e
- https://doi.org/10.1097/prs.0000000000006724
Abstract
Background: Whether to irradiate the tissue expander before implant exchange or to defer irradiation until after exchange in immediate, two-stage expander/implant reconstruction remains uncertain. The authors evaluated the effects of irradiation timing on complication rates and patient-reported outcomes in patients undergoing immediate expander/implant reconstruction. Methods: Immediate expander/implant reconstruction patients undergoing postmastectomy radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites with demographic, clinical, and complication data were analyzed. Patient-reported outcomes were assessed with BREAST-Q, Patient-Reported Outcomes Measurement Information System, and European Organisation for Research and Treatment of Cancer Breast Cancer–Specific Quality-of-Life Questionnaire surveys preoperatively and 2 years postoperatively. Survey scores and complication rates were analyzed using bivariate comparison and multivariable regressions. Results: Of 317 patients who met inclusion criteria, 237 underwent postmastectomy radiation therapy before expander/implant exchange (before-exchange cohort), and 80 did so after exchange (after-exchange cohort). Timing of radiation had no significant effect on risks of overall complications (OR, 1.25; p = 0.46), major complications (OR, 1.18; p = 0.62), or reconstructive failure (OR, 0.72; p = 0.49). Similarly, radiation timing had no significant effect on 2-year patient-reported outcomes measured by the BREAST-Q or the European Organisation for Research and Treatment of Cancer survey. Outcomes measured by the Patient-Reported Outcomes Measurement Information System showed less anxiety, fatigue, and depression in the after-exchange group. Compared with preoperative assessments, 2-year patient-reported outcomes significantly declined in both cohorts for Satisfaction with Breasts, Physical Well-Being, and Sexual Well-Being, but improved for anxiety and depression. Conclusions: Radiation timing (before or after exchange) had no significant effect on complication risks or on most patient-reported outcomes in immediate expander/implant reconstruction. Although lower levels of anxiety, depression, and fatigue were observed in the after-exchange group, these differences may not be clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.Keywords
This publication has 41 references indexed in Scilit:
- NCCN Guidelines Insights: Breast Cancer, Version 1.2017Journal of the National Comprehensive Cancer Network, 2017
- Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline UpdateJournal of Clinical Oncology, 2016
- Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology, 2015
- Monitoring patient-centered outcomes through the progression of breast reconstruction: a multicentered prospective longitudinal evaluationBreast Cancer Research and Treatment, 2014
- Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trialsThe Lancet, 2014
- A study of body image in long‐term breast cancer survivorsCancer, 2010
- Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complicationsBreast Cancer Research and Treatment, 2010
- Quality of Life Among Younger Women With Breast CancerJournal of Clinical Oncology, 2005
- Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recoveryBreast Cancer Research and Treatment, 1999
- Adjuvant Radiotherapy and Chemotherapy in Node-Positive Premenopausal Women with Breast CancerThe New England Journal of Medicine, 1997