Optimal Timing of Expander-to-Implant Exchange after Postmastectomy Radiation Therapy: 90-Day Complications and Patient-Reported Outcomes

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BACKGROUND: The optimal time for expander-to-implant exchange after postmastectomy radiation therapy (PMRT) remains unknown. The authors performed this study to identify the optimal interval between PMRT and expander-to-implant exchange to minimize complications and assess the impact of the time interval on patient-reported outcomes. METHODS: A single-institution, retrospective analysis was performed of patients who underwent 2-stage implant-based breast reconstruction with radiation from 2010 through 2024. The optimal time to expander-to-implant exchange for predicting any 90-day postoperative complication was identified using receiver operating characteristic curves and the Youden index. Multivariable logistic regression was used to assess the association between the dichotomized time interval and postoperative complications. Linear mixed-effects models were used to evaluate the impact on BREAST-Q scores. RESULTS: A total of 1242 patients were included. Ninety-day complications included surgical site infection (10%), reconstructive failure (6%), prosthetic exposure (3.4%), hematoma (0.9%), and seroma (0.8%). A total of 190 days was identified as the optimal time between PMRT and expander-to-implant exchange to reduce the risk of 90-day postoperative complications. Exchange within 190 days was independently associated with an increased risk of complications (OR, 1.64 [95% CI, 1.15 to 2.32]; P = 0.005) versus after 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 to 0.98]; P = 0.2), physical well-being of the chest (β = -1.4 [95% CI, -3.8 to 1.1]; P = 0.3), or psychosocial well-being (β = -1.5 [95% CI, -4.3 to 1.4]; P = 0.3). CONCLUSIONS: Delaying expander-to-implant exchange by 6 months after PMRT 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.

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