ABSTRACT: Breast Reconstruction Using Tissue Expanders and Implants
in Hodgkin's Patients with Prior Mantle Irradiation
Women treated for Hodgkin's disease with mantle irradiation have
an increased risk for developing breast cancer.
malignancy in Hodgkin's patients presents bilaterally in a younger
age group. Skin flap ischemia, poor skin expansion, implant extrusion,
capsular contracture, and poor cosmesis are common sequelae of
tissue expander/implant breast reconstruction after breast irradiation
for failed breast conservation therapy.
This has led most surgeons
to favor autologous tissue reconstruction in this setting. This
study was performed to determine the efficacy of tissue expander/implant
breast reconstruction in breast cancer patients who have been
treated with prior mantle irradiation for Hodgkin's disease.
A retrospective analysis of all breast cancer patients with a
history of Hodgkin's disease and mantle irradiation treated with
mastectomy and tissue expander/implant reconstruction between
1992 and 1999 was performed.
There were seven patients, with
a mean age of 35 years (range, 28 to 42 years). The average interval
between mantle irradiation and breast cancer diagnosis was 16
years (range, 12 to 23 years). All patients underwent two-stage
reconstruction. Textured surface tissue expanders were placed
in a complete submuscular position at the time of mastectomy.
Expansion was initiated 2 weeks after insertion and continued
on a weekly basis until completion. Expanders were replaced with
textured surface saline-filled implants as a second stage. Patients
were evaluated for skin flap ischemia, infection, quality of
skin expansion, implant extrusion, capsular contracture, rippling,
symmetry, and final aesthetic outcome.
Breast cancer was bilateral
in five patients and unilateral in two. Two patients did not
undergo simultaneous bilateral breast reconstruction because
of metachronous cancer development. One of the patients had an
initial transverse rectus abdominis muscle flap breast reconstruction,
followed by a tissue expander/implant reconstruction of the opposite
breast. The average follow-up was 3 years.
limited to one case of cellulitis after implant placement that
resolved with intravenous antibiotics. There were no cases of
skin flap ischemia, poor skin expansion, or implant extrusion.
Overall patient satisfaction was high and revisions were not
requested or required.
Symmetry was best achieved with bilateral
implants. This study demonstrates the efficacy of tissue expander/implant
breast reconstruction in patients treated with prior mantle irradiation.
In this series, tissue expansion was reliable with low morbidity.
Second-stage placement of permanent implants yielded good aesthetic
results without significant capsular contracture.
did not appear to compromise the prosthetic breast reconstruction.
Tissue expander/implant breast reconstruction should remain a
viable option in this category of irradiated patients.
Plastic and Reconstructive Surgery 1/02
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