Microvascular autologous breast reconstruction in the context of radiation therapy: Comparing two reconstructive algorithms

Background: When postmastectomy radiation therapy is anticipated* delaying autologous reconstruction prevents radiation delivery issues and radiation-induced contour irregularities. Delayed-immediate autologous breast reconstruction may allow for maintenance of the breast skin envelope as compared with delayed reconstruction with the temporary insertion of a tissue expander. The authors compared perioperative complications and revision surgery rates of comparative cohorts to determine which method is preferable. Methods: Delayed-immediate reconstruction was defined as placement of a temporary tissue expander in the first stage at the time of mastectomy before flap reconstruction*which occurred following postmastectomy radiation therapy. Delayed reconstruction was categorized as mastectomy with primary closure in the first stage followed by flap reconstruction. RESULTS:: One hundred fifty-two patients and 192 breasts met the study criteria for this retrospective review (delayed reconstruction*118 breasts*delayed-immediate autologous breast reconstruction*74 breasts). Patient age and body mass index were similar between groups (p >0.05). Perioperative first-stage complication rates were 8.5 percent in the delayed group and 10.8 percent in the delayed-immediate cohort (p = 0.81). Total flap loss (2.5 versus 4.1 percent*p = 0.68) and arterial (1.7 versus 1.4 percent*p = 0.82) and venous (4.3 versus 5.4 percent*p = 0.73) anastomotic revision rates were similar between the cohorts*respectively. Reoperative surgery occurred in 11.9 percent versus 9.6 percent in the delayed and delayed-immediate cohorts*respectively (p = 0.69). Conclusions: In comparing two treatment algorithms*flap-related complication rates are comparable. First-stage surgery results in a slightly increased complication rate in the delayed-immediate cohort. Improved overall results with delayed-immediate reconstruction are implied*given significantly decreased rates of revision surgery following flap reconstruction. Clinical Question/Level of Evidence: Therapeutic.