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Post-mactectomy Radiation Therapy In Patients Who Underwent Goldilocks Procedure With Two-staged Implant-based Reconstruction: A Clinical Outcomes Study
Doga Kuruoglu, MD1, Maria Yan, MD1, Samyd S. Bustos, MD1, Robert W. Mutter, MD1, Antonio J. Forte, MD,PhD,Ms2, Minh-Doan T. Nguyen, MD,PhD1, Jorys Martinez-Jorge, MD1, Christin Harless, MD1, Nho V. Tran, MD1, Judy C. Boughey, MD1, Oscar J. Manrique, MD1.
1Mayo Clinic, Rochester, MN, USA, 2Mayo Clinic, Jacksonville, FL, USA.

Purpose: Goldilocks procedure with two-staged implant-based breast reconstruction (IBR) has become an increasingly performed reconstructive surgical option, particularly in obese or patients with large ptotic breasts. Post-mastectomy radiation therapy (PMRT) may be related to increased complications in this group. However, no data currently exist. We analyzed clinical outcomes in patients who underwent Goldilocks procedure with two-staged IBR and who underwent PMRT.
Methods: Retrospective review of patients who underwent Goldilocks mastectomy and immediate two-staged IBR at our institution between 2014 and 2019. Patients who received PMRT were identified. Outcomes of irradiated breasts were compared with non-irradiated breasts. Demographics, clinical and surgical characteristics, first stage and second stage complications were compared. Either chi-square or Fisher's exact test were used to assess complication rates between groups.
Results: A total of 72 patients (n=127 breast cases) underwent Goldilocks procedure with IBR. A total of 86.6% (n = 110 cases) were bilateral, and 13.4% (n = 17 cases) were unilateral procedures. Nineteen cases underwent PMRT. Mean age at the time of reconstruction was 51.7 (SD=10.8) years. Mean body mass index at the time of reconstruction was 31.8 kg/m2 (SD=5.3). Median follow-up was 17 months (range: 6-72 months) from the first stage (Goldilocks procedure and tissue expander placement). Median follow-up was 11 months (3-68 months) from the second stage (tissue expander exchange to implant). First stage complication rates in irradiated versus non-irradiated breasts were as follows: seroma, 5.2% versus 3.7%; hematoma, 5.3% versus 0.9%; breast infection, 21% versus 3.7%; mastectomy skin flap full necrosis, 5.2% versus 1.8%; wound dehiscence, 21% versus 11%; capsular contracture, 5.6% versus 0%; and tissue expander explantation, 15.8% versus 2.7%. Second stage complication rates in irradiated versus non-irradiated breasts were as follows: seroma, 0% versus 1%; hematoma, 0% versus 0%; breast infection, 0% versus 4.3%; wound dehiscence, 0% versus 1%; capsular contracture, 18.1% versus 3.2%; and implant explantation, 9% versus 13%. On univariate analysis, PMRT was associated with a higher risk of tissue expander explantation (p=0.0428) and first stage breast infection requiring IV antibiotics or drainage (p=0.0174). Final reconstruction was completed in 88.2% (n=112), with successful implant-based breast reconstruction in 102 breasts (11 irradiated cases and 91 non-irradiated cases).
Conclusions: The Goldilocks procedure with two-staged IBR has been already described as a good reconstructive option for women undergoing mastectomy. However, based on this data, further counseling is necessary when patients undergo radiation therapy due to the higher complication rate.


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