T. Galbreath1, A. Eppler1, B. Irojah1, N. Young1, R. Grim1, D. M. Kenna1, A. Shah1, V. Ahuja1 1York Hospital,Surgery,York, PA, USA
Introduction:
Breast expanders used in immediate reconstruction following mastectomy either have an external metallic backstop port (EMP) that is connected to the expander by tubing, or an internal metallic backstop port (IMP) that is within the expander. It has been shown in the past that the metallic component can cause radiation scatter, but it unclear if the effect of scatter is clinically observable in recurrence rates.
Methods:
Data was collected for patients with breast cancer treated with mastectomy and post-operative radiation over the time period of 2000-2008 from a community hospital and surgery center. CPT codes searched include 19303, 19304, 19307; which correlate respectively with simple, subcutaneous, and modified radical mastectomy (MRM). Chart review was undertaken to categorize data into four groups: (1) no expander used, (2) muscle flap reconstruction, (3) expander with IMP or integrated port, and (4) expander with EMP or remote port. All patients included had similar radiation dosing. Each patient’s record was reviewed for findings of recurrence with follow-up minimum of 60 months. Chi-square test was used for comparisons. Inclusion criteria: modified radical mastectomy for local invasive ductal or lobular carcinoma, mastectomy with post-operative radiation, immediate breast reconstruction. Exclusionary criteria: re-operation for breast cancer, incompletion of radiation prescription or non-adherence to radiation prescription, those receiving radiation dosage of less than 50cGy, use of pre-operative radiation, mastectomy without radiation, tissue expander removal, exchange, or failure prior to completion of radiation therapy; other sources of en vivo attenuation; metastatic disease; inflammatory breast cancer; multifocal or bilateral breast cancer; less than 60 months of follow-up.
Results:
There were 102 cases that met inclusion criteria. The mean age of within the data set was 56.8 years of age. There were 70.6% who had no expander, 4.9% with muscle flap reconstruction, 18.6% with IMP, and 5.9% with EMP. A chi-square revealed there was no relationship between these 4 groups and recurrence (p = .066). A chi-square of IMP vs. EMP for recurrence also showed no significance (p= .759).
Conclusion:
There is no indication that the type of tissue expander used in immediate reconstruction following mastectomy for breast cancer impacts recurrence rates or effectiveness of postoperative radiation.