An assessment of the risks and benefits of immediate autologous breast reconstruction in patients undergoing postmastectomy radiation therapy

BACKGROUND: The utility of immediate autologous breast reconstruction in patients likely to undergo radiation therapy remains controversial. The purpose of this study was to perform a quantitative outcomes assessment of patients undergoing immediate free-flap breast reconstruction and postmastectomy radiation therapy (PMRT). METHODS: A retrospective chart review was performed of patients undergoing free-flap breast reconstruction by the senior authors (L.C.W. and J.M.S.) between 2005 and 2009. The treatment group included patients who underwent immediate free-flap breast reconstruction and received PMRT. The control group consisted of patients undergoing immediate breast reconstruction without PMRT. Variables assessed included postoperative complications and revision surgery. RESULTS: Four hundred seven women underwent immediate free-flap breast reconstruction for a total of 655 flaps. In the cohort that underwent unilateral reconstruction, there was a higher incidence of volume loss (28.26% vs 4.42%, P < 0.0001) and fat necrosis (19.57% vs 3.54%, P = 0.002) in the PMRT group. In the cohort that underwent bilateral reconstruction, there was a higher rate of volume loss for those in the PMRT group (19.75% vs 1.0%, P < 0.0001). However, for both patients who underwent unilateral reconstruction and those who underwent bilateral reconstruction, the PMRT group underwent similar rates of revision surgery. The cohort that underwent bilateral reconstruction experienced a higher incidence of volume loss in radiated perforator flaps (39%) vs muscle-sparing free transverse rectus abdominis myocutaneous flaps (12%; P = 0.013). CONCLUSIONS: Postmastectomy radiation therapy can result in volume loss and fat necrosis, yet there are no increases in other complications or revision procedures. The deleterious effects of PMRT do not preclude the decision for immediate autologous reconstruction.