Immediate Free Flap Reconstruction for Advanced-Stage Breast Cancer: Is It Safe?

Abstract

Therapeutic, IV.(Figure is included in full-text article.).

Muscle-Sparing TRAM Flap Does Not Protect Breast Reconstruction from Postmastectomy Radiation Damage Compared with the DIEP Flap

“…Some studies evaluating immediate autologous tissue-based reconstruction before PMRT have reported reasonable rates of complications and satisfactory cosmetic outcomes. 6,29,30,38 However, overall complication rates are often imprecisely defined, as reported overall complications may include complications at both the donor and recipient sites. 39 Even overall complication rates for only the recipient site are not significantly affected by PMRT, especially since radiation therapy is not typically begun until 1 or 2 months after the transfer of the microvascular flap.…”

“…Nevertheless, at this point, in patients with advanced stages of breast cancer, immediate breast reconstruction has not been shown to adversely affect local recurrence or overall survival rates. 6,23 Although it has been shown to be oncologically safe to perform immediate breast reconstruction with autologous tissue prior to administration of PMRT, it predisposes patients to the development of a high incidence of fat necrosis, which typically presents as a palpable mass. Any lesion in the breast after breast cancer treatment can be a source of significant anxiety for a breast cancer patient because it may potentially represent a recurrent tumor.…”

“…These surgeons have found the deleterious effects of PMRT to be acceptable and preferable to the delay in reconstruction and additional surgery required for the staged approach. 6,12,[26][27][28][29][30] Others have suggested that breast reconstruction with an MS FTRAM flap rather than a DIEP flap will avoid or decrease the deleterious effects of radiation because MS FTRAM flaps have a more robust blood supply. 31 However, it is not known whether irradiated MS FTRAM flaps experience less fat necrosis and fibrosis than irradiated DIEP flaps.…”

“…[1][2][3][4][5][6][7] However, PMRT can compromise the outcomes of immediate breast reconstructions that use abdominal-based free flaps such as deep inferior epigastric perforator (DIEP) flaps or muscle-sparing free transverse rectus abdominis musculocutaneous (MS FTRAM) flaps. [6][7][8][9][10][11][12][13][14] Radiation therapy has been shown to cause fibrosis within the stroma of fat tissue where the blood vessels supply the adipose cells, which can result in cell death and subsequent fat necrosis. Fat necrosis and fibrosis in free flaps can lead to atrophy and contracture of the reconstructed breast and patient dissatisfaction ( Figure 1).…”

A Classification System for Partial and Complete DIEP Flap Necrosis Based on a Review of 17,096 DIEP Flaps in 693 Articles Including Analysis of 152 Total Flap Failures

“…Partial necrosis definitions ranged from absolute area, 15,16 proportion of flap lost, 37 to surgical management. [38][39][40] Some articles also described it as any skin loss caused by ischemia.…”