A Paradigm Shift: Outcomes of Early Autologous Breast Reconstruction after Radiation Therapy

Abstract

Background Radiation creates significant challenges for breast reconstruction. There is no consensus regarding optimal timing for autologous reconstruction following radiation. This study explores clearly defined, shorter time intervals between completion of radiation and reconstruction than previously reported. Methods A retrospective review was performed on patients who underwent autologous reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Cohorts were selected by time elapsed between radiation and autologous reconstruction including <3 months, 3 to 6 months, 6 to 9 months, 9 to 12 months, 12 to 24 months, and >24 months. Analysis compared baseline characteristics, operative details, complications, revision rates, and BREAST-Q scores. Analysis of variance was used for continuous variables and chi-square for discrete variables. Results In total, 462 radiated patients underwent 717 flaps. There were 69 patients at <3 months (14.9%), 97 at 3 to 6 months (21%), 64 at 6 to 9 months (13.9%), 36 at 9 to 12 months (7.8%), 73 at 12 to 24 months (15.8%), and 123 at >24 months (26.6%). Age, time from mastectomy, and failure of primary reconstruction were higher at >24 months (p < 0.001). There was no difference between cohorts in intraoperative complications in radiated or nonradiated breasts. There was no difference in acute and late postoperative complications between cohorts. Wound-healing complications in radiated sides were lowest at <3 months and 3 to 6 months (5/69 [7.3%] and 11/97 [11.3%], respectively) compared with other groups (18.8–22.2%) but did not reach significance (p = 0.11). More fat graft revisions occurred at <3 months (p = 0.003). Conclusion Reconstruction can be safely performed within 3 months after radiation without increases in intraoperative, acute, or late reconstructive complications.

The Impact of Timing of Delayed Autologous Breast Reconstruction following Postmastectomy Radiation Therapy on Postoperative Morbidity

“…33 Additionally, at a single academic institution, Elver et al demonstrated the efficacy of early reconstruction in patients receiving radiation, reporting lower levels of wound complications in those who received reconstruction in less than 3 months, though this finding was nonsignificant as the study was underpowered ( p > 0.05). 34 Our study builds upon these findings performed across multiple institutions with statistical significance, illustrating reconstruction may be safely performed in the 0 to 3 month period after PMRT. In a retrospective study of 189 patients, Baumann et al demonstrated that waiting longer than 12 months after the completion of PMRT was associated with fewer complications, but the earliest reconstruction in this study was performed at 3 months, and the authors did not conduct a subgroup analysis of the women reconstructed within 12 months.…”

“…17 Exploring the possibility of earlier reconstruction, Elver et al recently published their single-institution experience of 462 radiated patients and did not find a difference in acute and late postoperative complications amongst patients undergoing reconstruction <3 months after radiation compared with those undergoing reconstruction at later intervals. 34 A limitation of this study, as has been the case in others, is the relatively small sample size (69 patients in the <3 month group) in some of the early reconstruction groups of patients.…”

Visual Perception of Breast Free Flap Size Is Influenced by Radiation Changes of Surrounding Tissue

“…Many studies have tried to evaluate the effect of the timing of radiation therapy in relation to the timing of breast reconstruction with mixed results reported. [31][32][33] Additionally, the need for This article is protected by copyright. All rights reserved.…”

“…Many studies have tried to evaluate the effect of the timing of RT in relation to the timing of breast reconstruction with mixed results reported. [28][29][30] Additionally, the need for postoperative radiation has led many surgeons to favor the delayed-immediate approach with in an attempt to improve their aesthetic results and decrease their overall complications while getting patients into adjuvant treatment as expeditiously as possible. 31,32 There is sparse literature on the exact effects of unilateral radiation on the aesthetic outcomes of autologous breast reconstructions.…”

Functional Nasal Surgery in a Compromised Soft Tissue Envelope

“…Some breast cancer surgeons use the 3-month point after radiation if acute inflammation has resolved in order to expedite reconstruction. 5 The literature on the subject is almost exclusively limited to breast cancer reconstruction.…”