Skip to main content
Top
Published in: BMC Cancer 1/2021

Open Access 01-12-2021 | Mastectomy | Research article

Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?

Authors: Sung Mi Jung, Byung-Joon Jeon, Jinsun Woo, Jai Min Ryu, Se Kyung Lee, Byung-Joo Chae, Jonghan Yu, Seok Won Kim, Seok Jin Nam, Jai-Kyong Pyon, Goo-Hyun Mun, Sa Ik Bang, Jeong Eon Lee

Published in: BMC Cancer | Issue 1/2021

Login to get access

Abstract

Background

Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander.

Methods

We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%).

Results

In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications.

Conclusions

IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR.

Trial registration

Patients were selected and registered retrospectively, and medical records were evaluated.
Literature
1.
go back to reference U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2019 submission data (1999–2017): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.cdc.gov/cancer/dataviz, released in June 2020. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2019 submission data (1999–2017): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.​cdc.​gov/​cancer/​dataviz, released in June 2020.
2.
go back to reference Coughlin SS. Epidemiology of breast cancer in women. In: Ahmad A, editor. Breast cancer metastasis and drug resistance: challenges and Progress. Edn. Cham: Springer International Publishing; 2019. p. 9–29.CrossRef Coughlin SS. Epidemiology of breast cancer in women. In: Ahmad A, editor. Breast cancer metastasis and drug resistance: challenges and Progress. Edn. Cham: Springer International Publishing; 2019. p. 9–29.CrossRef
3.
go back to reference Heimes AS, Stewen K, Hasenburg A. Psychosocial aspects of immediate versus delayed breast reconstruction. Breast Care (Basel). 2017;12(6):374–7.CrossRef Heimes AS, Stewen K, Hasenburg A. Psychosocial aspects of immediate versus delayed breast reconstruction. Breast Care (Basel). 2017;12(6):374–7.CrossRef
4.
go back to reference Bykowski MR, Emelife PI, Emelife NN, Chen W, Panetta NJ, de la Cruz C. Nipple-areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer. J Plast Reconstr Aesthet Surg. 2017;70(2):209–14.CrossRef Bykowski MR, Emelife PI, Emelife NN, Chen W, Panetta NJ, de la Cruz C. Nipple-areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer. J Plast Reconstr Aesthet Surg. 2017;70(2):209–14.CrossRef
5.
go back to reference Baek SH, Bae SJ, Yoon CI, Park SE, Cha CH, Ahn SG, et al. Immediate breast reconstruction does not have a clinically significant impact on adjuvant treatment delay and subsequent survival outcomes. J Breast Cancer. 2019;22(1):109–19.CrossRef Baek SH, Bae SJ, Yoon CI, Park SE, Cha CH, Ahn SG, et al. Immediate breast reconstruction does not have a clinically significant impact on adjuvant treatment delay and subsequent survival outcomes. J Breast Cancer. 2019;22(1):109–19.CrossRef
6.
go back to reference Cemal Y, Albornoz CR, Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, et al. A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg. 2013;131(3):320e–6e.CrossRef Cemal Y, Albornoz CR, Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, et al. A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg. 2013;131(3):320e–6e.CrossRef
7.
go back to reference Nguyen AT, Chang DW. Discussion: a paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131(1):24–5.CrossRef Nguyen AT, Chang DW. Discussion: a paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2013;131(1):24–5.CrossRef
8.
go back to reference Dolen UC, Schmidt AC, Um GT, Sharma K, Naughton M, Zoberi I, et al. Impact of Neoadjuvant and adjuvant chemotherapy on immediate tissue expander breast reconstruction. Ann Surg Oncol. 2016;23(7):2357–66.CrossRef Dolen UC, Schmidt AC, Um GT, Sharma K, Naughton M, Zoberi I, et al. Impact of Neoadjuvant and adjuvant chemotherapy on immediate tissue expander breast reconstruction. Ann Surg Oncol. 2016;23(7):2357–66.CrossRef
9.
go back to reference Mitchem J, Herrmann D, Margenthaler JA, Aft RL. Impact of neoadjuvant chemotherapy on rate of tissue expander/implant loss and progression to successful breast reconstruction following mastectomy. Am J Surg. 2008;196(4):519–22.CrossRef Mitchem J, Herrmann D, Margenthaler JA, Aft RL. Impact of neoadjuvant chemotherapy on rate of tissue expander/implant loss and progression to successful breast reconstruction following mastectomy. Am J Surg. 2008;196(4):519–22.CrossRef
10.
go back to reference Hamahata A, Kubo K, Takei H, Saitou T, Hayashi Y, Matsumoto H, et al. Impact of immediate breast reconstruction on postoperative adjuvant chemotherapy: a single center study. Breast Cancer. 2015;22(3):287–91.CrossRef Hamahata A, Kubo K, Takei H, Saitou T, Hayashi Y, Matsumoto H, et al. Impact of immediate breast reconstruction on postoperative adjuvant chemotherapy: a single center study. Breast Cancer. 2015;22(3):287–91.CrossRef
11.
go back to reference Jethwa KR, Kahila MM, Whitaker TJ, Harmsen WS, Corbin KS, Park SS, et al. Immediate tissue expander or implant-based breast reconstruction does not compromise the oncologic delivery of post-mastectomy radiotherapy (PMRT). Breast Cancer Res Treat. 2017;164(1):237–44.CrossRef Jethwa KR, Kahila MM, Whitaker TJ, Harmsen WS, Corbin KS, Park SS, et al. Immediate tissue expander or implant-based breast reconstruction does not compromise the oncologic delivery of post-mastectomy radiotherapy (PMRT). Breast Cancer Res Treat. 2017;164(1):237–44.CrossRef
13.
go back to reference Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef
14.
go back to reference Ryu JM, Paik HJ, Park S, Yi HW, Nam SJ, Kim SW, et al. Oncologic outcomes after immediate breast reconstruction following Total mastectomy in patients with breast cancer: a matched case-control study. J Breast Cancer. 2017;20(1):74–81.CrossRef Ryu JM, Paik HJ, Park S, Yi HW, Nam SJ, Kim SW, et al. Oncologic outcomes after immediate breast reconstruction following Total mastectomy in patients with breast cancer: a matched case-control study. J Breast Cancer. 2017;20(1):74–81.CrossRef
15.
go back to reference Ryu JM, Park S, Paik HJ, Nam SJ, Kim SW, Lee SK, et al. Oncologic safety of immediate breast reconstruction in breast cancer patients who underwent Neoadjuvant chemotherapy: short-term outcomes of a matched case-control study. Clin Breast Cancer. 2017;17(3):204–10.CrossRef Ryu JM, Park S, Paik HJ, Nam SJ, Kim SW, Lee SK, et al. Oncologic safety of immediate breast reconstruction in breast cancer patients who underwent Neoadjuvant chemotherapy: short-term outcomes of a matched case-control study. Clin Breast Cancer. 2017;17(3):204–10.CrossRef
16.
go back to reference Lee SB, Lee JW, Son BH, Eom JS, Kim EK, Lee TJ, et al. Oncologic safety of skin-sparing mastectomy followed by immediate reconstruction in young patients with breast cancer. Asian J Surg. 2019;42(1):274–82.CrossRef Lee SB, Lee JW, Son BH, Eom JS, Kim EK, Lee TJ, et al. Oncologic safety of skin-sparing mastectomy followed by immediate reconstruction in young patients with breast cancer. Asian J Surg. 2019;42(1):274–82.CrossRef
17.
go back to reference Furey PC, Macgillivray DC, Castiglione CL, Allen L. Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer. J Surg Oncol. 1994;55(3):194–7.CrossRef Furey PC, Macgillivray DC, Castiglione CL, Allen L. Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer. J Surg Oncol. 1994;55(3):194–7.CrossRef
18.
go back to reference Decker MR, Greenblatt DY, Havlena J, Wilke LG, Greenberg CC, Neuman HB. Impact of neoadjuvant chemotherapy on wound complications after breast surgery. Surgery. 2012;152(3):382–8.CrossRef Decker MR, Greenblatt DY, Havlena J, Wilke LG, Greenberg CC, Neuman HB. Impact of neoadjuvant chemotherapy on wound complications after breast surgery. Surgery. 2012;152(3):382–8.CrossRef
19.
go back to reference Song J, Zhang X, Liu Q, Peng J, Liang X, Shen Y, et al. Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PLoS One. 2014;9(5):e98225.CrossRef Song J, Zhang X, Liu Q, Peng J, Liang X, Shen Y, et al. Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PLoS One. 2014;9(5):e98225.CrossRef
20.
go back to reference Warren Peled A, Itakura K, Foster RD, Hamolsky D, Tanaka J, Ewing C, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145(9):880–5.CrossRef Warren Peled A, Itakura K, Foster RD, Hamolsky D, Tanaka J, Ewing C, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg. 2010;145(9):880–5.CrossRef
21.
go back to reference Yoon AP, Qi J, Brown DL, Kim HM, Hamill JB, Erdmann-Sager J, et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast (Edinburgh, Scotland). 2018;37:72–9.CrossRef Yoon AP, Qi J, Brown DL, Kim HM, Hamill JB, Erdmann-Sager J, et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. Breast (Edinburgh, Scotland). 2018;37:72–9.CrossRef
22.
go back to reference Anker CJ, Hymas RV, Ahluwalia R, Kokeny KE, Avizonis V, Boucher KM, et al. The effect of radiation on complication rates and patient satisfaction in breast reconstruction using temporary tissue expanders and permanent implants. Breast J. 2015;21(3):233–40.CrossRef Anker CJ, Hymas RV, Ahluwalia R, Kokeny KE, Avizonis V, Boucher KM, et al. The effect of radiation on complication rates and patient satisfaction in breast reconstruction using temporary tissue expanders and permanent implants. Breast J. 2015;21(3):233–40.CrossRef
23.
go back to reference Lam TC, Borotkanics R, Hsieh F, Salinas J, Boyages J. Immediate two-stage prosthetic breast reconstruction failure: radiation is not the only culprit. Plast Reconstr Surg. 2018;141(6):1315–24.CrossRef Lam TC, Borotkanics R, Hsieh F, Salinas J, Boyages J. Immediate two-stage prosthetic breast reconstruction failure: radiation is not the only culprit. Plast Reconstr Surg. 2018;141(6):1315–24.CrossRef
24.
go back to reference Allué Cabañuz M, Arribas Del Amo MD, Gil Romea I, Val-Carreres Rivera MP, Sousa Domínguez R, Güemes Sánchez AT. Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: a safe option? Cir Esp. 2019;97(10):575–81.CrossRef Allué Cabañuz M, Arribas Del Amo MD, Gil Romea I, Val-Carreres Rivera MP, Sousa Domínguez R, Güemes Sánchez AT. Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: a safe option? Cir Esp. 2019;97(10):575–81.CrossRef
25.
go back to reference Garvey PB, Villa MT, Rozanski AT, Liu J, Robb GL, Beahm EK. The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients. Plast Reconstr Surg. 2012;130(5):991–1000.CrossRef Garvey PB, Villa MT, Rozanski AT, Liu J, Robb GL, Beahm EK. The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients. Plast Reconstr Surg. 2012;130(5):991–1000.CrossRef
26.
go back to reference Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM. Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. Breast (Edinburgh, Scotland). 2017;32:7–12.CrossRef Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM. Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. Breast (Edinburgh, Scotland). 2017;32:7–12.CrossRef
27.
go back to reference Sada A, Day CN, Hoskin TL, Degnim AC, Habermann EB, Hieken TJ. Mastectomy and immediate breast reconstruction in the elderly: trends and outcomes. Surgery. 2019;166(4):709–14.CrossRef Sada A, Day CN, Hoskin TL, Degnim AC, Habermann EB, Hieken TJ. Mastectomy and immediate breast reconstruction in the elderly: trends and outcomes. Surgery. 2019;166(4):709–14.CrossRef
28.
go back to reference Lee S-J, Park C, Lee JY, Kim S, Kwon PJ, Kim W, et al. Yoon Y-s: generation of pure lymphatic endothelial cells from human pluripotent stem cells and their therapeutic effects on wound repair. Sci Rep. 2015;5:11019.CrossRef Lee S-J, Park C, Lee JY, Kim S, Kwon PJ, Kim W, et al. Yoon Y-s: generation of pure lymphatic endothelial cells from human pluripotent stem cells and their therapeutic effects on wound repair. Sci Rep. 2015;5:11019.CrossRef
29.
go back to reference Young-Afat DA, Gregorowitsch ML, van den Bongard DH, Burgmans I, van der Pol CC, Witkamp AJ, et al. Breast edema following breast-conserving surgery and radiotherapy: patient-reported prevalence, determinants, and effect on health-related quality of life. JNCI Cancer Spectr. 2019;3(2):pkz011.CrossRef Young-Afat DA, Gregorowitsch ML, van den Bongard DH, Burgmans I, van der Pol CC, Witkamp AJ, et al. Breast edema following breast-conserving surgery and radiotherapy: patient-reported prevalence, determinants, and effect on health-related quality of life. JNCI Cancer Spectr. 2019;3(2):pkz011.CrossRef
30.
go back to reference Killelea BK, Long JB, Dang W, Mougalian SS, Evans SB, Gross CP, et al. Associations between sentinel lymph node biopsy and complications for patients with ductal carcinoma in situ. Ann Surg Oncol. 2018;25(6):1521–9.CrossRef Killelea BK, Long JB, Dang W, Mougalian SS, Evans SB, Gross CP, et al. Associations between sentinel lymph node biopsy and complications for patients with ductal carcinoma in situ. Ann Surg Oncol. 2018;25(6):1521–9.CrossRef
31.
go back to reference Cuadrado GA, de Andrade MFC, Akamatsu FE, Jacomo AL. Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns. Breast Cancer Res Treat. 2018;169(2):251–6.CrossRef Cuadrado GA, de Andrade MFC, Akamatsu FE, Jacomo AL. Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns. Breast Cancer Res Treat. 2018;169(2):251–6.CrossRef
32.
go back to reference Ota D, Fukuuchi A, Iwahira Y, Kato T, Takeuchi M, Okamoto J, et al. Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients. Breast Cancer. 2016;23(3):400–6.CrossRef Ota D, Fukuuchi A, Iwahira Y, Kato T, Takeuchi M, Okamoto J, et al. Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients. Breast Cancer. 2016;23(3):400–6.CrossRef
33.
go back to reference Moyer KE, Potochny JD. Technique for seroma drainage in implant-based breast reconstruction. J Plast Reconstr Aesthet Surg. 2012;65(12):1614–7.CrossRef Moyer KE, Potochny JD. Technique for seroma drainage in implant-based breast reconstruction. J Plast Reconstr Aesthet Surg. 2012;65(12):1614–7.CrossRef
34.
go back to reference ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol. 2014;21(3):802–7.CrossRef ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol. 2014;21(3):802–7.CrossRef
35.
go back to reference Boostrom SY, Throckmorton AD, Boughey JC, Holifield AC, Zakaria S, Hoskin TL, et al. Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg. 2009;208(1):148–50.CrossRef Boostrom SY, Throckmorton AD, Boughey JC, Holifield AC, Zakaria S, Hoskin TL, et al. Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg. 2009;208(1):148–50.CrossRef
36.
go back to reference Coveney EC, O'Dwyer PJ, Geraghty JG, O'Higgins NJ. Effect of closing dead space on seroma formation after mastectomy--a prospective randomized clinical trial. Eur J Surg Oncol. 1993;19(2):143–6.PubMed Coveney EC, O'Dwyer PJ, Geraghty JG, O'Higgins NJ. Effect of closing dead space on seroma formation after mastectomy--a prospective randomized clinical trial. Eur J Surg Oncol. 1993;19(2):143–6.PubMed
37.
go back to reference Thomson DR, Trevatt AE, Furniss D. When should axillary drains be removed? A meta-analysis of time-limited versus volume controlled strategies for timing of drain removal following axillary lymphadenectomy. J Plast Reconstr Aesthet Surg. 2016;69(12):1614–20.CrossRef Thomson DR, Trevatt AE, Furniss D. When should axillary drains be removed? A meta-analysis of time-limited versus volume controlled strategies for timing of drain removal following axillary lymphadenectomy. J Plast Reconstr Aesthet Surg. 2016;69(12):1614–20.CrossRef
38.
go back to reference Unalp HR, Onal MA. Analysis of risk factors affecting the development of seromas following breast cancer surgeries: seromas following breast cancer surgeries. Breast J. 2007;13(6):588–92.CrossRef Unalp HR, Onal MA. Analysis of risk factors affecting the development of seromas following breast cancer surgeries: seromas following breast cancer surgeries. Breast J. 2007;13(6):588–92.CrossRef
39.
go back to reference El-Sabawi B, Sosin M, Carey JN, Nahabedian MY, Patel KM. Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol. 2015;112(5):458–64.CrossRef El-Sabawi B, Sosin M, Carey JN, Nahabedian MY, Patel KM. Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol. 2015;112(5):458–64.CrossRef
40.
go back to reference Sekiguchi K, Kawamori J, Yamauchi H. Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology. Breast Cancer. 2017;24(4):511–20.CrossRef Sekiguchi K, Kawamori J, Yamauchi H. Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology. Breast Cancer. 2017;24(4):511–20.CrossRef
41.
go back to reference Oh E, Chim H, Soltanian HT. The effects of neoadjuvant and adjuvant chemotherapy on the surgical outcomes of breast reconstruction. J Plast Reconstr Aesthet Surg. 2012;65(10):e267–80.CrossRef Oh E, Chim H, Soltanian HT. The effects of neoadjuvant and adjuvant chemotherapy on the surgical outcomes of breast reconstruction. J Plast Reconstr Aesthet Surg. 2012;65(10):e267–80.CrossRef
Metadata
Title
Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?
Authors
Sung Mi Jung
Byung-Joon Jeon
Jinsun Woo
Jai Min Ryu
Se Kyung Lee
Byung-Joo Chae
Jonghan Yu
Seok Won Kim
Seok Jin Nam
Jai-Kyong Pyon
Goo-Hyun Mun
Sa Ik Bang
Jeong Eon Lee
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-020-07729-w

Other articles of this Issue 1/2021

BMC Cancer 1/2021 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine