Does Post-Operative Radiation Increase Complications or the Need for Revision Surgery in Patients Undergoing Immediate Free Flap Breast Reconstruction?

Purpose: The utility of immediate autologous breast reconstruction in patients likely to undergo radiation therapy is controversial. The purpose of this study is to perform a quantitative outcomes assessment of patients undergoing immediate free flap breast reconstruction and subsequent radiation therapy.

Methods: A retrospective chart review was performed of all patients undergoing free flap breast reconstruction by the senior authors (LCW, JMS) between 2004 and 2009. The treatment group included all patients who underwent unilateral free flap breast reconstruction and received subsequent radiation therapy. The control group consisted of patients undergoing immediate unilateral breast reconstruction without any form of radiation therapy. Outcome variables collected included rates of: 1) fat necrosis, 2) wound infection, 3) mastectomy skin flap necrosis, 4) hematoma, 5) seroma, and 6) delayed wound healing, 7) volume loss, and 8) contour deformities of the reconstructed breast. Furthermore, the need for revision surgery to attain optimal breast symmetry and contour was quantified.

Results: Forty-six patients were included in the study group. The control group of non-irradiated patients included 115 patients. Patients undergoing immediate breast reconstruction and subsequent radiation were more likely to suffer from volume loss (28% vs. 5%, p = .001), fat necrosis (20% vs. 4%, p = .001), and delayed wound healing (48% vs. 26%, p = .008), of the reconstructed breast. Rates of contour deformity (44% vs. 53%, p = .32), wound infection (15% vs. 9%, p = .224), mastectomy skin flap necrosis (14% vs. 7%, p = .189), hematoma (4% vs. 3%, p = .792), and seroma (2% vs. 4%, p = .23) were not significantly different. Patients undergoing immediate breast reconstruction did not undergo significantly different rates of revisional surgery (52% vs. 57%, p = .616), fat grafting (11% vs. 5%, p = .20), implant placement (9% vs. 4%, p = .262), additional flap placement (0% vs. 1%, p = .526), or local tissue rearrangement (30% vs. 22%, p = .245) of the reconstructed breast.

Conclusions: Traditionally, autologous breast reconstruction has been delayed in patients likely to undergo radiation therapy. We have demonstrated that although post reconstruction radiation does shrink the breast mound, it does not result in any greater complications or revision rates in the unilateral breast patient.