“Immediate versus delayed autologous breast reconstruction in patients undergoing post‐mastectomy radiation therapy: A paradigm shift”

Abstract

Background While negative impacts of radiation on breast reconstruction have been well accepted, timing of autologous breast reconstruction in the setting of postmastectomy radiation therapy (PMRT) is still evolving. This study aims to address the dilemma of breast reconstruction timing in patients receiving PMRT. Methods A retrospective chart review was performed evaluating patients who underwent PMRT and autologous breast reconstruction. Postoperative complication and revision rates were compared. Results Thirty‐six immediate (immediate breast reconstruction [IBR]) and 89 delayed reconstructions (delayed breast reconstruction [DBR]) were included with comparable patient characteristics between groups. Overall complication rates were not significantly different, or when separately assessing for surgical site infections, wound dehiscence, fat necrosis, or substantial volume loss. No free flaps were lost in either group. Revision rates were significantly lower in the IBR group (p = 0.02). DBR resulted in appreciably larger volumes of fat grafting to the therapeutically reconstructed breast (p = 0.01) and more contralateral mastopexies (p = 0.02). No significant difference was observed in fat necrosis excision, breast reduction, or need for secondary flap reconstruction or prosthetic use for volume loss. Conclusions IBR in the setting of PMRT does not result in higher rates of complications and requires fewer overall revisions, making it a compelling option for patients undergoing PMRT.

Radiation and free flaps: what is the optimal timing?

“…Pooled incidence of wound healing complications was 14% in flaps exposed to PMRT compared to 10% in flaps delayed after radiation, incidence of infection was 6% compared to 4%, incidence of hematoma was 1% compared 2%, and seroma rates were 4% in both groups. Furthermore, a follow-up paper to previous work by this senior author (Chang DW), providing an update on immediate vs. delayed autologous breast reconstruction paradigms, also found no difference in rates of surgical site infections, wound dehiscence, or fat necrosis ( 31 ). The number of revisions was in fact lower in the immediate reconstruction group than in the delayed group.…”

“… Pre- and post-operative images of a patient who underwent bilateral immediate autologous reconstruction and unilateral PMRT, demonstrating excellent symmetry [from: Wu et al ( 31 )]. (A) Native breasts with right sided malignancy.…”

“…Such conclusions are difficult to translate however, without detailed information regarding radiation regimens and timing of surgery. Subsequent studies examining vascular complications have demonstrated no increased incidence of thrombosis or flap loss ( 24 , 31 , 37 ). A meta-analysis of observational studies identified no difference in early complication rates, or need for future revision surgery, when comparing immediate autologous breast reconstruction with and without PMRT ( 41 ).…”