Table 5.
Reconstruction complications
| Patient | Reconstruction type | Proton technique | Total dose (Gy) | Time from RT start –MRC/ ARF surgery (mo) | MRC +/- ARF | Reason for complication | Revision surgery details |
|---|---|---|---|---|---|---|---|
| 1 | Expander (prepectoral) | PBS | 50.4 | 35.2 | MRC | Capsular contracture | Capsulotomy and implant exchange |
| 2 | Expander (prepectoral) | PBS | 50 | 29.5 | MRC | Capsular contracture | Capsulotomy and implant exchange with latissimus muscle transposition flap to cover new implant |
| 3 | Implant (postpectoral) | PS | 66.4 | 29.0 | MRC | Capsular contracture | Capsulotomy and implant exchange with breast fat grafting |
| 4 | Implant (postpectoral) | PBS | 50.4 | 43.2 | MRC | Capsular contracture | Capsulotomy and implant exchange |
| 5 | Implant (postpectoral) | PS | 50.4 | 7.8 | MRC | Infection | Implant exchange; this was followed by a free flap reconstruction due to failure of the implant exchange 14 mo radiation start, which was intact at last follow-up |
| 6 | Implant (postpectoral) | PS | 50.4 | 22.2 | MRC with ARF | Capsular contracture | Implant removal without implant replacement |
| 7 | Implant (postpectoral) | PBS | 60 | 36.9 | MRC with ARF | Infection | Implant removal, debridement without implant replacement |
| 8 | MSFTRAM flap | PBS | 50 | 12.4 | MRC with ARF | Fat necrosis of flap and skin necrosis of lower pole of mastectomy | Removal of entire breast reconstruction after failed partial debridement with poor wound healing |
| 9 | MSFTRAM flap | PBS | 50.4 | 25.4 | MRC | Fat necrosis | Excision of fat necrosis |
Abbreviations: ARF = absolute reconstruction failure; MRC = major reconstruction complication; MSFTRAM = muscle sparing free transverse rectus abdominis myocutaneous; PBS = pencil beam scanning; PS = passively scattered; RT = radiation.