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A 10-Year Experience with Mastectomy and Tissue Expander Placement to Facilitate Subsequent Radiation and Reconstruction

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

An integrated approach to skin sparing mastectomy with tissue expander placement followed by radiotherapy and delayed reconstruction was initiated in our institution in 2002. The purpose of this study was to assess the surgical outcomes of this strategy.

Methods

Between September 2002 and August 2013, a total of 384 reconstructions had a tissue expander placed at the time of mastectomy and subsequently underwent radiotherapy. Rates and causes of tissue expander explantation before, during, and after radiotherapy, as well as tumor specific outcomes and reconstruction approaches, were collected.

Results

Median follow-up after diagnosis was 5.6 (range 1.3–13.4) years. In the study cohort, 364 patients (94.8%) had stage II–III breast cancer, and 7 patients (1.8%) had locally recurrent disease. The 5-year rates of actuarial locoregional control, disease-free survival, and overall survival were 99.2, 86.1, and 92.4%, respectively. The intended delayed-immediate reconstruction was subsequently completed in 325 of 384 mastectomies (84.6% of the study cohort). Of the remaining 59 tissue expanders, 1 was explanted before radiotherapy, 1 during radiotherapy, and 7 patients (1.8%) were lost to follow-up. Fifty patients (13.0%) required tissue expander explantation after radiation and before their planned final reconstruction, primarily due to cellulitis. Nonetheless, the cumulative rate of completed reconstructions was 89.6%. The median time from placement of the tissue expander until reconstruction was 12 (interquartile range 9–15) months.

Conclusions

Tissue expander placement at skin-sparing mastectomy in patients who require radiotherapy appears to be a viable strategy for combining reconstruction and radiotherapy.

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Acknowledgement

Supported in part by Cancer Center Support (Core) Grant CA016672 from the National Institute of Cancer, National Institutes of Health, to The University of Texas MD Anderson Cancer Center.

Disclosure

None of the authors has any commercial interest or conflict to disclose related to the present work.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA

    Zeina Ayoub MD, Eric A. Strom MD, George H. Perkins MD, Wendy A. Woodward MD, PhD, Welela Tereffe MD, MPH, Benjamin D. Smith MD, Simona F. Shaitelman MD, Michael C. Stauder MD & Karen E. Hoffman MD

  2. Department of Radiation Oncology, Clinica IRAM, Santiago, Chile

    Valentina Ovalle MD

  3. Department of Surgical Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA

    Sarah M. DeSnyder MD & Henry M. Kuerer MD, PhD

  4. Department of Plastic Surgery, UT M.D. Anderson Cancer Center, Houston, TX, USA

    Patrick B. Garvey MD & Mark W. Clemens MD

  5. Department of Breast Medical Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA

    Carlos H. Barcenas MD, MSc

  6. Kronowitz Plastic Surgery, Houston, TX, USA

    Steven Kronowitz MD

Authors
  1. Zeina Ayoub MD
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  2. Eric A. Strom MD
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  3. Valentina Ovalle MD
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  4. George H. Perkins MD
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  5. Wendy A. Woodward MD, PhD
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  6. Welela Tereffe MD, MPH
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  7. Benjamin D. Smith MD
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  8. Simona F. Shaitelman MD
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  9. Michael C. Stauder MD
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  10. Karen E. Hoffman MD
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  11. Sarah M. DeSnyder MD
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  12. Patrick B. Garvey MD
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  13. Mark W. Clemens MD
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  14. Carlos H. Barcenas MD, MSc
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  15. Henry M. Kuerer MD, PhD
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  16. Steven Kronowitz MD
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Corresponding author

Correspondence to Eric A. Strom MD.

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Ayoub, Z., Strom, E.A., Ovalle, V. et al. A 10-Year Experience with Mastectomy and Tissue Expander Placement to Facilitate Subsequent Radiation and Reconstruction. Ann Surg Oncol 24, 2965–2971 (2017). https://doi.org/10.1245/s10434-017-5956-6

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  • DOI: https://doi.org/10.1245/s10434-017-5956-6

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