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J Reconstr Microsurg 2023; 39(02): 111-119
DOI: 10.1055/s-0042-1750139
Original Article

A Paradigm Shift: Outcomes of Early Autologous Breast Reconstruction after Radiation Therapy

Ashlie A. Elver 
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Katie G. Egan 
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Melissa E. Cullom
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Niaman Nazir
2   Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
,
Braden M. Johnson
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
MarcArthur Limpiado
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Julie Holding
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
Eric C. Lai
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
,
James A. Butterworth
1   Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas
› Author Affiliations
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Abstract

Background Radiation creates significant challenges for breast reconstruction. There is no consensus regarding optimal timing for autologous reconstruction following radiation. This study explores clearly defined, shorter time intervals between completion of radiation and reconstruction than previously reported.

Methods A retrospective review was performed on patients who underwent autologous reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Cohorts were selected by time elapsed between radiation and autologous reconstruction including <3 months, 3 to 6 months, 6 to 9 months, 9 to 12 months, 12 to 24 months, and >24 months. Analysis compared baseline characteristics, operative details, complications, revision rates, and BREAST-Q scores. Analysis of variance was used for continuous variables and chi-square for discrete variables.

Results In total, 462 radiated patients underwent 717 flaps. There were 69 patients at <3 months (14.9%), 97 at 3 to 6 months (21%), 64 at 6 to 9 months (13.9%), 36 at 9 to 12 months (7.8%), 73 at 12 to 24 months (15.8%), and 123 at >24 months (26.6%). Age, time from mastectomy, and failure of primary reconstruction were higher at >24 months (p < 0.001). There was no difference between cohorts in intraoperative complications in radiated or nonradiated breasts. There was no difference in acute and late postoperative complications between cohorts. Wound-healing complications in radiated sides were lowest at <3 months and 3 to 6 months (5/69 [7.3%] and 11/97 [11.3%], respectively) compared with other groups (18.8–22.2%) but did not reach significance (p = 0.11). More fat graft revisions occurred at <3 months (p = 0.003).

Conclusion Reconstruction can be safely performed within 3 months after radiation without increases in intraoperative, acute, or late reconstructive complications.

Keywords

radiation - autologous reconstruction - breast reconstruction

Note

This article was accepted for podium presentation at the 2021 American Society of Plastic Surgeons Meeting in Atlanta, GA.




Publication History

Received: 17 October 2021

Accepted: 23 April 2022

Article published online:
28 June 2022

© 2022. Thieme. All rights reserved.

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