Radiation Effects on Breast Reconstruction with the Deep Inferior Epigastric Perforator Flap

Abstract

Immediate breast reconstruction has important advantages over delayed reconstruction, including a shorter operative time and decreased psychological distress for the patient. However, the authors' experiences with the deep inferior epigastric perforator flap demonstrate variable aesthetic outcomes among patients who undergo radiation postoperatively. To establish an association between radiation and poor postoperative results, a matched-pairs analysis was conducted. Thirty irradiated patients were paired with 30 nonirradiated patients, according to age and body mass index. For each group, the incidence of fat necrosis, fibrosis/shrinkage, and flap contracture was recorded. In addition, an aesthetic evaluation was conducted to compare before-and-after images of 10 irradiated patients with those of 10 nonirradiated patients from similar time periods. The images were randomized and blindly evaluated by a panel of eight judges. A five-point scale was used to evaluate symmetry, aesthetic proportion, and the appearance of the superior pole. Statistical analysis demonstrated a significant difference in the score changes for irradiated and nonirradiated patients, according to all three criteria. Nonirradiated patient scores increased by one-half point, and irradiated patient scores decreased by one-half point. In addition, the incidences of fat necrosis, fibrosis, and flap contracture were all significantly higher among the irradiated group. These results suggest that when possible, reconstruction should be delayed until after radiation therapy is complete. Persons who smoke or are obese may be at particular risk for complications following radiation therapy.

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

“…Most studies find that radiotherapy in an implant-based reconstruction increases complications and late failure rates (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The results of the present study are in line with those of other studies in this field (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)30,31,33).…”

“…Radiotherapy after mastectomy but before reconstruction has not been shown to increase complications after autologous reconstruction (25); however, not all studies are in agreement (26,27). Certain studies show that postoperative radiotherapy to the breast reconstructed with a deep inferior epigastric perforator flap (DIEP) or transverse rectus abdominis myocutaneous (TRAM) flap has no effect on the reconstruction (28,29), while several others show a considerable negative effect on the final results of autologous reconstruction (24,26,(30)(31)(32)(33)(34).…”

Immediate-DElayed AutoLogous (IDEAL) Breast Reconstruction with the DIEP Flap

“…In the study of Motwani et al it was concluded that immediate breast reconstruction poses challenges for the treatment planning of post mastectomy radiation therapy because of suboptimal field coverage and organ protection (19). Also, patients who have their breast reconstructed before their radiotherapy are exposed to increased late complication rates (20) and unpredictable outcomes (21) due to which the timing of breast reconstruction has to be planned carefully. Patients that receive radiotherapy after DIEP-flap reconstruction show significantly increased rates of fat necrosis, fibrosis and contracture (21), similar applies to implant based reconstruction (22,23).…”

Breast reconstruction and radiation therapy: A Canadian perspective

“…Breast reconstruction in the patient requiring radiation therapy There is substantial risk to the reconstructed breast undergoing radiation (7)(8)(9)(10). In autologous reconstruction, flaps can shrink and develop contour abnormalities.…”