Abstract
Background The ideal time to perform reconstruction after the completion of postmastectomy radiation
therapy (PMRT) in patients with locally advanced breast cancer is currently unknown.
We evaluate the association between the timing of delayed autologous breast reconstruction
following PMRT and postoperative complications.
Methods Patients who underwent mastectomy, PMRT, and then delayed autologous breast reconstruction
from 2009 to 2016 were identified from the Truven Health MarketScan Research Databases.
Timing of reconstruction following PMRT was grouped 0–3, 3–6, 6–12, 12–24, and after
24 months. Multivariable models were used to assess associations between timing of
reconstruction following PMRT and key measures of morbidity.
Results A total of 1,039 patients met inclusion criteria. The rate of any complications for
the analytic cohort was 39.4%, including 13.3% of patients who experienced wound complications
and 11.3% of patients requiring additional flaps. Unadjusted rates of complications
increased from 23.4% between 0 and 3 months to 49.4% between 3 and 6 months and decreased
thereafter. Need for additional flaps was highest within 3 to 6 months (14.0%). Multivariate
analysis revealed higher rates of any complications when reconstruction was performed
between 3 and 6 months (odds ratio [OR]: 3.04, p < 0.001), 6 and 12 months (OR: 2.66, p < 0.001), or 12 and 24 months (OR: 2.13, p = 0.001) after PMRT. No difference in complications were noted in reconstructions
performed after 24 months compared with those performed before 3 months (p > 0.05). However, rates of wound complications were least likely in reconstructions
after 24 months (OR: 0.34, p = 0.035).
Conclusion These findings suggest plastic surgeons may consider performing autologous breast
reconstruction early for select patients, before 3 months following PMRT without increasing
postoperative morbidity.
Keywords
breast reconstruction - radiation - autologous breast reconstruction - timing - morbidity
