Optimal Timing of Delayed Microvascular Breast Reconstruction after Radiation Therapy

Abstract

Background The purpose of this study was to determine the optimal timing of delayed microvascular breast reconstruction after completion of postmastectomy radiation therapy (PMRT). The authors evaluated whether the timing of reconstruction after PMRT completion affects the development of major postoperative complications. We hypothesize that delayed microvascular breast reconstruction can be safely performed within 12 months of PMRT completion. Methods A retrospective chart review of microvascular, autologous breast reconstructions at Brigham and Women's Hospital from 2007 to 2019 was performed. Logistic regression analysis and marginal estimation methods were used to estimate the probability of any major complication (flap compromise requiring operative intervention, hematoma formation requiring evacuation, infection requiring readmission, and flap necrosis requiring operative debridement) occurring in 2-month intervals after PMRT. Patients were classified as having undergone reconstruction 0 to 12 months after PMRT (group 1), 12 to 18 months after PMRT (group 2), or 18 to 50 months after PMRT (group 3). Results A total of 303 patients were identified. All patients received postmastectomy radiation (n = 143 group 1, n = 57 group 2, n = 103 group 3). Mean follow-up time was 71.4 ± 38 months. Patients in group 1 were significantly younger and more likely to have undergone neoadjuvant chemotherapy (p < 0.05). Major complications occurred in 10% of patients. There was no significant difference in the development of major complications between the three groups (p = 0.57). Although not statistically significant, the probability of any major complication peaked 2 to 6 months after PMRT completion. Conclusion There was no significant difference in major complications among patients who underwent delayed, microvascular breast reconstruction within versus beyond 1 year of PMRT completion. These findings suggest that delayed microvascular breast reconstruction can be safely performed beginning 6 months after PMRT completion.

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.…”

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

“…In this study, the investigators found no statistical significance between timing of reconstruction after PMRT and complications, though they did find a nonsignificant increase in complications in the 2 to 6 month cohorts. 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.…”

Postmastectomy radiotherapy in breast reconstruction: Current controversies and trends

“…However, in another study, Momoh et al [ 21 ] reported that there was no significant difference in the incidence of complications between patients who underwent BR sooner than 12 months after PMRT and those who underwent BR later and came to the same conclusion regarding these patients when BR was performed sooner or later than 6 months after PMRT. A recently published retrospective study investigated 303 patients who underwent delayed microvascular BR after PMRT [ 22 ]. The patients were divided into three groups according to whether they underwent reconstruction at 0–12 months, 12–18 months, or 18–50 months after PMRT.…”