Abstract
Background Postmastectomy radiation therapy (PMRT) is an important component in the treatment
of locally advanced breast cancer. Optimal timing of therapy in relation to autologous
breast reconstruction (ABR) remains clinically debated. Herein, we comparatively analyze
short- and long-term outcomes between immediate ABR (I-ABR) and delayed-immediate
ABR (DI-ABR) in the setting of PMRT.
Methods Adult patients undergoing ABR with PMRT were separated into cohorts based on reconstructive
timeline: I-ABR or DI-ABR. The groups were propensity matched 1:1 by age, body mass
index, and comorbidities. Surgical site events and long-term clinical outcomes (readmissions,
reoperations, and revision procedures) were collected. Univariate analyses were completed
using Pearson's chi-squared tests and Fisher's exact tests, and statistical significance
was set at p < 0.05.
Results One hundred and thirty-two flaps (66 in each cohort) were identified for inclusion.
Patients with I-ABR were more likely to experience fat necrosis (p = 0.034) and skin necrosis (p < 0.001), require additional office visits (p < 0.001) and outpatient surgeries (p = 0.015) to manage complications, and undergo revision surgery after reconstruction
(p < 0.001). DI-ABR patients, however, had a 42.4% incidence of complications following
tissue expander placement prior to reconstruction, with 16.7% of patients requiring
reoperation during this time. Only one patient (I-ABR) experienced flap loss due to
a vascular complication.
Conclusion The complications encountered in both of these groups were not prohibitive to offering
either treatment. Patients should be made aware of the specific and unique risks of
these reconstruction timelines and involved throughout the entire decision-making
process. Plastic surgeons should continue to strive to elucidate innovative approaches
that facilitate enhanced quality of life without compromising oncologic therapy.
Keywords
postmastectomy radiation therapy - tissue expanders - delayed-immediate autologous
breast reconstruction - immediate autologous breast reconstruction
