JAMA Surgery: Plastic Surgery (non-facial) Topic Collection

Start by Decreasing Unnecessary Postmastectomy Irradiation Comment on “Using Complications Associated With Postmastectomy Radiation and Immediate Breast Reconstruction to Improve Surgical Decision Making” Decreasing Unnecessary Postmastectomy Irradiation

Beatty J. — Wed, 01 Sep 2010 00:00:00 GMT

The Christante et al article describes the effect of IRB and postmastectomy chest wall irradiation on postmastectomy complication rates. For patients with no reconstruction, complication rates rose with PMRT from 3% to 7%. For delayed reconstruction, complication rates rose with PMRT from 0 of 12 patients to 2 of 9 patients. For the patients who underwent IRB, complication rates rose with PMRT from 16% (16 of 98) to 42% (14 of 33). To avoid IRB in patients who will have PMRT, they suggest doing IRB only in SLNB-negative patients and those with T1 tumors. Unfortunately, they do not provide the preoperative primary tumor and SLN information to validate this recommendation. The recommendation is too restrictive and would require all potential IRB patients to have an additional operation prior to mastectomy.

Chemotherapy and Breast Reconstruction Comment on “Impact of Chemotherapy on Postoperative Complications After Mastectomy and Immediate Breast Reconstruction” Chemotherapy and Breast Reconstruction

Giuliano AE. — Wed, 01 Sep 2010 00:00:00 GMT

This study examines the impact of chemotherapy on complications after 163 consecutive mastectomies with immediate reconstruction. The authors examine the infection rate, reoperative rate, prosthesis loss, skin necrosis, hematoma, donor-site complications, and flap loss. The overall complication rate of more than 30% is high for an elective procedure, and many of these complications are very difficult to determine retrospectively and may be underestimated. Some, however, are not, such as reoperation or prosthesis loss. The authors report a statistically significant increased infection rate among patients who received postoperative adjuvant chemotherapy but not neoadjuvant chemotherapy.

Impact of Chemotherapy on Postoperative Complications After Mastectomy and Immediate Breast Reconstruction Mastectomy and Immediate Breast Reconstruction

Warren Peled A, Itakura K, Foster RD, et al. — Wed, 01 Sep 2010 00:00:00 GMT

Objectives

To determine the impact of chemotherapy and the timing of chemotherapy on postoperative outcomes after mastectomy and immediate breast reconstruction.

Design

Retrospective review.

Setting

University tertiary care institution.

Patients

One hundred sixty-three consecutive patients undergoing mastectomy and immediate breast reconstruction.

Intervention

Systemic chemotherapy for breast cancer.

Main Outcome Measures

Postoperative complications following mastectomy and immediate breast reconstruction.

Results

One hundred sixty-three patients underwent mastectomy and immediate breast reconstruction during the study period, with a mean postoperative follow-up of 19.2 months. Sixty-six percent of the patients had expander/implant reconstruction, while 33% underwent autologous reconstruction. Fifty-seven patients received neoadjuvant chemotherapy and 41 received postoperative chemotherapy. Eighteen patients (44%) in the adjuvant chemotherapy cohort developed postoperative infections, compared with 13 patients (23%) in the neoadjuvant chemotherapy group and 16 patients (25%) who did not receive any chemotherapy (P = .05). Overall, 31% of patients had a complication requiring an unplanned return to the operating room; this rate did not differ between groups (P = .79). Of patients who underwent expander/implant reconstruction, 8 women (26%) in the neoadjuvant chemotherapy cohort, 7 women (22%) in the adjuvant chemotherapy cohort, and 8 women (18%) without chemotherapy required expander or implant removal (P = .70).

Conclusions

Although the highest rate of surgical site infections was in the adjuvant chemotherapy group, there were no differences between groups with respect to unplanned return to the operating room, expander loss, and donor-site complications. Neither the inclusion of chemotherapy nor the timing of its administration significantly affected the complication rates after mastectomy and immediate breast reconstruction in this population.