Should Immediate Autologous Breast Reconstruction be considered in Women who require Post-Mastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Abstract

Background

In women who require post-mastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. We aim to prospectively evaluate postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy.

Methods

Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium Study, who received post-mastectomy radiotherapy and had immediate or delayed free abdominal-based autologous breast reconstruction were identified. Postoperative complications at one and two years after reconstruction were assessed. Patient reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively, at one and two-years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes.

Results

A total of 175 patients met our inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients. 93.5% of the immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9% immediate and 26.9% delayed at one year; p=0.54). Patients with delayed reconstruction reported significantly lower pre-reconstruction scores (p<0.0001) for satisfaction with breast, psychosocial and sexual well-being than did patients with immediate reconstruction. At one and two years postoperatively, both groups of patients reported comparable levels of satisfaction in assessed BREAST-Q domains.

Conclusions

From this prospective cohort, immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient’s perspective, were not compromised by flap exposure to radiation therapy.