Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy

Purpose: To report our institution's experience of complications and cosmetic results among patients who underwent modified radical mastectomy followed by reconstruction and radiation therapy (RT). Methods and Materials: Between 1987 and 2002, 85 patients with breast cancer underwent modified radical mastectomy, breast reconstruction, and postoperative RT. Reconstruction consisted of tissue expander/implant (TE/I) in 50 patients and an autologous transverse rectus abdominis myocutaneous (TRAM) flap in 35 patients. The primary end point of this study was the actuarial incidence of major and minor complications involving the reconstruction. Cosmesis was also assessed at each follow-up visit. Results: The median follow-up from reconstruction was 28 months. The 5-year major complication rate was 0% in the TRAM group vs. 5% in the TE/I group (p = 0.21). The 5-year minor complication rate was 39% for the TRAM group vs. 14% for the TE/I group (p = 0.04). None (0%) of the TRAM complications required any corrective surgery, whereas 2 (33%) of the TE/I complications required implant removal. Of the TRAM patients with complications, 100% had superior cosmetic scores of excellent/good compared to only 17% of the TE/I patients who had complications (p = 0.003). Use of our custom-fashioned bolus resulted in a lower complication rate compared with standard bolus (p = 0.05). Conclusions: Patients treated with breast reconstruction and RT can experience a very low rate of major complications. We demonstrate no significant difference in the overall rate of major complications between TRAM and TE/I patients. Bolus can be safely used during postmastectomy RT with reconstruction, and we advocate the use of a custom wax bolus in the treatment of these patients. Postmastectomy RT should be considered in all eligible patients, even in the setting of reconstruction. (C) 2004 Elsevier Inc.