Optimal Timing of Expander-to-Implant Exchange After Post-Mastectomy Radiation Therapy: 90-day Complications and Patient-Reported Outcomes.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 41315054.
- Also identified by DOI 10.1097/PRS.0000000000012626.
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Abstract
The optimal time for expander-to-implant exchange after post-mastectomy radiation therapy (PMRT) remains unknown. This study identified the optimal interval between PMRT and expander-to-implant exchange to minimize complications and assessed the impact of this interval on patient-reported outcomes. Single-institution, retrospective analysis of patients who underwent two-stage implant-based breast reconstruction with radiation from 2010-2024. The optimal time to expander-to-implant exchange for predicting any 90-day postoperative complication was identified using receiver operating characteristic curves and Youden's index. Multivariable logistic regression assessed the association between the dichotomized time interval and postoperative complications. Linear mixed-effects models evaluated the impact on BREAST-Q scores. 1,242 patients were included. 90-day complications included surgical site infection (10%), reconstructive failure (6%), prosthetic exposure (3.4%), hematoma (0.9%), and seroma (0.8%). 190 days was identified as the optimal time between PMRT and expander-to-implant exchange to reduce the risk of 90-day post-operative complications. Implant exchange ≤190 days was independently associated with an increased risk of complications (OR: 1.64, 95% CI: 1.15-2.32; p=0.005) compared to >190 days. BREAST-Q scores were not influenced by the timing of implant exchange for satisfaction with breasts (β=-1.6, 95% CI: -4.3-0.98; p=0.2), physical well-being of the chest (β=-1.4, 95% CI: -3.8-1.1; p=0.3), or psychosocial well-being (β=-1.5, 95% CI: -4.3-1.4; p=0.3). Delaying expander-to-implant exchange by approximately 6 months after PMRT significantly reduces the risk of 90-day complications without adversely affecting patient-reported outcomes. Individualized reconstructive timing can incorporate this interval to mitigate complications while preserving patient satisfaction and quality of life.