Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Stephanie L. Kwei

Subject Area(s)

Surgery

Abstract

The optimal timing of expander-implant exchange in the setting of post mastectomy radiation remains unclear with prior reports yielding inconsistent and variable results. The purpose of this study was to characterize complications associated with the sequencing of expander-implant breast reconstruction before or after radiation therapy and to compare the outcomes between early (< 4 months) and late (>4 months) expander-implant exchange in the subset of patients who received radiation prior to exchange.

The medical records of all patients receiving post-mastectomy radiation therapy in the setting of tissue expander-implant breast reconstruction between June 2004 - June 2011 at Yale-New Haven hospital were reviewed retrospectively. Patients were first classified as having undergone expander-implant exchange prior to the initiation of radiation or after the completion of radiation. Patients who underwent expander-implant exchange after radiation were then classified as having undergone exchange early (<4 months following radiation) or late (>4 months following radiation). All complications requiring additional surgery or hospitalization were recorded.

Fifty-five eligible patients were identified as having undergone 56 two-stage tissue expander-implant breast reconstructions. 22 reconstructions underwent exchange prior to radiation and 34 reconstructions underwent exchange following radiation. There was no significant difference in overall complication rate (54.55% vs 47.06%, p=0.785) or reconstruction failure rate (13.64% vs 20.59%, p=0.724) between the two cohorts. 20 reconstructions underwent exchange <4 months following radiation and14 underwent exchange >4 months following radiation. There was no significant difference in overall complication rate (40% vs 57.14%, p=0.487) or failure rate (25% vs 14.29%, p=0.672) between the two groups. Trends suggest a higher rate of infection in patients who underwent earlier exchange (30% vs 14.29%, p=0.422) and a higher rate of capsular contracture in patients who underwent later exchange (5% vs 21.43%, p=0.283), however statistical significance was not reached.

Our findings suggest that neither the sequencing nor timing of expander-implant exchange in the setting of radiation has an impact on overall complication or reconstruction failure rate. However, the timing of exchange may impact the type of complication encountered.

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