Delayed breast reconstruction with autologous free flap after radiation therapy: Vascular complications and aesthetic outcomes

Abstract

Background The safety and outcome of breast reconstruction after radiotherapy are controversial, and the aesthetic aspects have not been studied extensively. We compared the results of vascular anastomosis, the incidence of postoperative complications, and aesthetic appearance between patients who had and had not received radiotherapy who then had undergone delayed breast reconstruction with autologous free flaps from abdomen, thighs, and buttocks. Methods We investigated 196 flaps implanted in patients who did not receive radiotherapy and 78 flaps implanted in patients who received radiotherapy before breast reconstruction in 256 patients. Of the 274 flaps, 230 came from the abdomen, 27 from the thighs, 14 from the buttocks, and 3 from other anatomic locations. We evaluated aesthetic outcomes in 107 patients who had not received radiotherapy and 45 who had. Results We found no significant differences between the two groups in incidence of vascular reanastomosis, time required for anastomosis, or incidence of unplanned reoperation. Complications such as flap necrosis were rare in both groups. Aesthetic outcomes were significantly better in the patients who had not received radiotherapy. Among the patients who had received radiotherapy, the aesthetic results were superior after two-stage reconstruction than after one-stage reconstruction. Conclusions Breast reconstruction with autologous free flaps can be performed safely in patients who have received radiotherapy, but the aesthetic result is slightly inferior to that in patients who had not received radiotherapy. In patients who have received radiotherapy, two-stage reconstruction tends to produce more aesthetically pleasing results than does one-stage reconstruction, but one-stage reconstruction is recommended if the breast skin exhibits radiation-induced changes.