1283 - Patterns of Care and Treatment-Related Complications Following Breast Reconstruction after Mastectomy for Breast Cancers (KROG 24-06 Study)

09:47am - 09:53am ET

Room 254

Presenter(s)

In Ah Kim, MD, PhD - Seoul National University Bundang Hospital, Seongnamsi, Kyeonggido

I. A. Kim¹, D. Y. Kim², K. Kim³, S. S. Kim⁴, J. H. Hong⁵, H. Kim⁶, Y. J. Kim⁷, Y. B. Kim⁸, K. H. Shin⁹, J. Kwon¹⁰, A. R. Chang¹¹, S. J. Ahn¹², J. H. Choi¹³, S. Kim¹⁴, J. H. Kim¹⁵, and Y. Park¹⁶; ¹Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South), ²Korea University Anam Hospital, Korea University College of Medicine, Korea, Korea, Republic of (South), ³2Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, Republic of (South), ⁴Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), ⁵Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South), ⁶Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South), ⁷National Cancer Center, Goyang, Korea, Republic of (South), ⁸Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South), ⁹Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South), ¹⁰Department of Radiation Oncology, Chungnam National University Hospital, Daejeon, Korea, Republic of (South), ¹¹Soonchunhyang University Seoul Hospital, Seoul, Korea, Republic of (South), ¹²Chonnam National University Medical School, Seoul, Korea, Republic of (South), ¹³Chung-Ang University Hospital, Seoul, Korea, Republic of (South), ¹⁴13Department of Radiation Oncology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea, Republic of (South), ¹⁵Department of Radiation Oncology, Keimyung University School of medicine, Daegu, Korea, Republic of (South), ¹⁶Ewha Woman's University Seoul Hospital, Seoul, Korea, Republic of (South)

Purpose/Objective(s):

Breast reconstruction after mastectomy is increasingly performed to improve cosmetic and psychological outcomes in breast cancer survivors. This study aimed to investigate contemporary practice patterns of care and treatment-related complications, with a particular focus on the interaction between breast reconstruction and postmastectomy radiation therapy (PMRT).

Materials/Methods:

This multicenter retrospective study included 1,592 breast cancer patients from 14 institutions who underwent breast reconstruction after mastectomy between January 2017 and December 2020. Breast-related complications were analyzed according to the type (autologous vs. implant-based) and timing (immediate vs. delayed 1stage vs. delayed 2 stages) of reconstruction, as well as the use of PMRT.

Results:

The median follow-up time was 69.7 months (range, 3.3-124.0 months). Of all patients, 1,083 underwent immedate reconstruction, 471 received two-stage delayed reconstruction, and 38 had one-stage delayed reconstruction. The most common reconstruction type was implant-based (54.8%) followed by deep inferior epigastric perforator (DIEP) flap (21.7%) and transverse rectus abdominis myocutaneous flap (15.3%). Among the cohort, 1,123 patients received adjuvant PMRT and 469 did not. Of those receiving PMRT, 62.0% were treated with conventional fractionation and 38.0% with hypofractionation.

In patients receiving PMRT, immediate autologous reconstruction was associated with significantly fewer major complications compared with implant-based reconstruction. Conversely, in patients without PMRT, immediate autologous reconstruction was associated with a higher rate of major complications than implant-based reconstruction. Multivariate analysis identified prepectoral implant placement as a significant predictor of both any and major complications, irrespective of PMRT. No significant differences in recurrence or complications were observed according to RT fractionation or radiotherapy technique (three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy).

Conclusion:

Although the details varied significantly between institutions, immediate autologous reconstruction demonstrated distinct complication profiles according to PMRT status, showing fewer major complications in irradiated patients but higher complication rates in non-irradiated ones. Prepectoral implant placement was independently associated with an increased risk of any and major complications. These findings highlight the importance of institution-specific and individualized reconstructive strategies that account for anticipated PMRT and implant positioning to minimize postoperative complications.