for those of you deciding between immediate and delayed reconstruction

[Lani]

this article may be helpful:

1: Int J Radiat Oncol Biol Phys. 2006 Jun 7; [Epub ahead of print] Related Articles, Links

The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy.

Motwani SB, Strom EA, Schechter NR, Butler CE, Lee GK, Langstein HN, Kronowitz SJ, Meric-Bernstam F, Ibrahim NK, Buchholz TA.

Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA.

PURPOSE: To quantify the impact of immediate breast reconstruction on postmastectomy radiation therapy (PMRT) planning. METHODS: A total of 110 patients (112 treatment plans) who had mastectomy with immediate reconstruction followed by radiotherapy were compared with contemporaneous stage-matched patients who had undergone mastectomy without intervening reconstruction. A scoring system was used to assess optimal radiotherapy planning using four parameters: breadth of chest wall coverage, treatment of the ipsilateral internal mammary chain, minimization of lung, and avoidance of heart. An "optimal" plan achieved all objectives or a minor 0.5 point deduction; "moderately" compromised treatment plans had 1.0 or 1.5 point deductions; and "major" compromised plans had >/=2.0 point deductions. RESULTS: Of the 112 PMRT plans scored after reconstruction, 52% had compromises compared with 7% of matched controls (p < 0.0001). Of the compromised plans after reconstruction, 33% were considered to be moderately compromised plans and 19% were major compromised treatment plans. Optimal chest wall coverage, treatment of the ipsilateral internal mammary chain, lung minimization, and heart avoidance was achieved in 79%, 45%, 84%, and 84% of the plans in the group undergoing immediate reconstruction, compared respectively with 100%, 93%, 97%, and 92% of the plans in the control group (p < 0.0001, p < 0.0001, p = 0.0015, and p = 0.1435). In patients with reconstructions, 67% of the "major" compromised radiotherapy plans were left-sided (p < 0.16). CONCLUSIONS: Radiation treatment planning after immediate breast reconstruction was compromised in more than half of the patients (52%), with the largest compromises observed in those with left-sided cancers. For patients with locally advanced breast cancer, the potential for compromised PMRT planning should be considered when deciding between immediate and delayed reconstruction.

PMID: 16765534 [PubMed - as supplied by publisher]

[R.B.]

Some thought provoking statistics.

RB

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

1: Ann Chir. 2003 Jun;128(5):310-5. Related Articles, Links
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[Morbidity of the trans rectus abdominis musculocutaneous flap in breast reconstruction. Retrospective study about 125 patients]

[Article in French]

Gimbergues P, Le Bouedec G, Pomel C, Janny-Peyronie M, Dauplat J.

Service de chirurgie, unite de chirurgie oncologique (Pr J. Dauplat), centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 cedex 1, Clermont-Ferrand, France. pgimbergues@cjp.u-clermont1.fr

OBJECTIVE: To evaluate, in our experience, the morbidity of the trans rectus abdominis musculocutaneous flap (TF), to determine the risks factors and the advantage of surgical delay procedure. PATIENTS AND METHODS: TF was used for 125 consecutive breast reconstructions. Thirty-eight patients (30,4%) had recidive after conservative treatment and 62 (49,6%) have been included in a procedure associating chemotherapy, radiation therapy and mastectomy with immediate breast reconstruction (IBR), 31 patients were obese (24,8%), 14 were smoker (11,2%), 118 (94,4%) had prior thoracic radiation, 97 (77,6%) had a surgical delay procedure by ligation of the inferior epigastric pedicle, 115 (92%) had IBR, 99 TF were unipediculed and 26 were bipediculed. RESULTS: Immediate morbidity was: 21 necrosis of the flap (16,8%) among 1 total necrosis (0,8%), 6 hematomas (4,8%). Secondary morbidity was: 14 fat necrosis (11,2%), 9 eventrations (7,2%), 6 hernias (4,8%). The only statistic factor founded for ischemic complication was obesity (P = 0,036). The abdominal repair with interposed mesh was the only factor who decreased significatively (P = 0,013) the wall complication rate. The surgical procedure delay did not reduce ischemic complication rate (P = 0,92). CONCLUSION: TF can be performed with an acceptable complication rate in institution who realise frequently breast reconstruction procedure. Surgical delay procedure in our experience must be reconsidered.

PMID: 12878067 [PubMed - indexed for MEDLINE]