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A Multicenter Study Of Post-radiation Morbidity Following Dual-stage Implant-based Breast Reconstruction: Fields, Fractionation, And Patient Factors
Saïd C. Azoury, MD1, Timothy C. Olsen, MBA, BS
1, Ariel Gabay, BS
2, Aamirah McCutchen, MD, MPH
1, Maggie Hornick, MD
1, Robyn B. Broach, PhD
1, Tajah Bell, BS
2, Evan Matros, MD, MPH, MMSc
2, Babak J. Mehrara, MD
2, Robert J. Allen, Jr., MD
2, Suhail K. Kanchwala, MD
1, Joseph M. Serletti, MD
1, Jonas A. Nelson, MD, MPH
2.
1University of Pennsylvania, Philadelphia, PA, USA,
2Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: To determine how radiation fractionation and field design affect complications following permanent implant placement in dual-stage implant-based breast reconstruction (IBBR).
METHODS: A multi-institutional, breast-level dataset of dual-stage IBBR procedures (2014-2025) was analyzed for complications after permanent implant placement. Multivariable logistic models with patient-clustered standard errors evaluated fractionation (conventional fractionated radiation therapy [CFRT], hypo-fractionated [HFRT], ultra-HFRT) versus no RT and fields (chest wall, axilla, supraclavicular region, and internal mammary nodes [IMN]), adjusted for age and BMI.
RESULTS: Among 7,843 breasts (RT- 6,331; RT+ 1,512) with a median post-implant follow-up 59.2 months [IQR 35.8-81.0], the occurrence of any complication was higher in the irradiated group (Table 1). On multivariable analysis, CFRT increased odds of infection (OR 3.17; 95% CI 1.92-5.23) and any complication (OR 2.04; 1.42-2.94) compared with no RT. HFRT also increased the odds of any complication (OR 3.00; 1.41-6.41). IMN RT independently increased risk of capsular contracture (OR 3.43; 1.30-9.08). Elevated BMI increased odds of any complication (OR 1.03; 1.01-1.05) and mastectomy skin necrosis (OR 1.08; 1.02-1.14), while older age was protective against implant exposure (OR 0.97; 0.94-0.99).
CONCLUSION: Fractionation was not the dominant driver of post-implant morbidity; field selection (notably IMN) and BMI showed similarly consistent associations. Therefore, when IMN is planned or BMI is elevated, heightened surveillance for infection, contracture, and related complications warrants consideration.
Post-implant outcomes in post-mastectomy radiation therapy IBBR patients.| Characteristic | Overall(%) | RT-(%) | RT+(%) | P |
| Infection | 258 (3.3) | 148 (2.3) | 110 (7.3) | <0.001 |
| Capsular contracture | 96 (1.2) | 46 (0.7) | 50 (3.3) | <0.001 |
| RTOR | 190 (2.4) | 112 (1.8) | 78 (5.2) | <0.001 |
| Implant exposure | 86 (1.1) | 56 (0.9) | 30 (2.0) | <0.001 |
| Wound breakdown | 12 (0.2) | 4 (0.1) | 8 (0.5) | <0.001 |
| Hematoma | 39 (0.5) | 26 (0.4) | 13 (0.9) | 0.025 |
| Seroma | 80 (1.0) | 50 (0.8) | 30 (2.0) | <0.001 |
| MSFN | 64 (0.8) | 60 (0.9) | 4 (0.3) | 0.006 |
| Total complications | 823 (10.5) | 502 (7.9) | 323 (21.3) | <0.001 |
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