Does Previous Chest Wall Irradiation Increase Vascular Complications in Free Autologous Breast Reconstruction?

Abstract

Prereconstruction radiation therapy increases the rate of vascular complications in free flap breast reconstruction, the majority of which appear intraoperatively. Although radiation does not hinder the overall success of reconstruction or contribute to postoperative complications, surgeons should be aware that working in a previously irradiated field carries additional technical risk.

Complications Following Abdominal-Based Free Flap Breast Reconstruction: Is a 30 days Complication Rate Representative?

“…Fosnot et al [13], studying the effect of previous radiation on vascular complications after free autologous breast reconstruction, with a total of 1025 free flaps, found an increase in acute complications and added technical difficulties during surgery, but with no significant long-term negative implications for the reconstructive outcome [13].…”

Two-Stage Prosthetic Breast Reconstruction Using AlloDerm Including Outcomes of Different Timings of Radiotherapy

“…This is borne out by the abundant literature that describes significantly more complications in any type of reconstruction of the irradiated breast. [22][23][24][25][26][27][28][29][30][31][32][33][34] The most valuable reports would be those that include both irradiated and nonirradiated breasts but that go on to segregate the data based on the timing of breast irradiation. The same is true regarding two-stage breast reconstruction with tissue expanders as opposed to one-stage direct-to-implant reconstruction.…”

Bilateral Free Flap Breast Reconstruction After Unilateral Radiation

“…[1][2][3][4][5] Our group previously demonstrated that there is a significant increase in intraoperative microvascular complications in patients who have undergone radiation before free flap breast reconstruction, but no difference in postoperative complications or major outcomes. 6 Although this was a well-designed study that controlled for multiple factors including concurrent chemotherapy and patient comorbidities, this examination was performed looking specifically at flap complications and issue per flap, including bilateral and unilateral patients.…”