Immediate versus delayed autologous breast reconstruction: A retrospective matched cohort study of irradiated patients.

Background: The impact of radiotherapy on breast reconstructions is not completely understood. The purpose of this study was to evaluate long-term effects of radiation therapy in relation to timing of autologous breast reconstruction.

Methods: A total of 1247 patients undergoing autologous breast reconstruction at the University Hospitals of Leuven between August 1997 and October 2013 were subjected to a retrospective matched cohort study. Each patient who underwent immediate breast reconstruction (IBR) and received post mastectomy radiotherapy (PMRT) were matched with two patients receiving PMRT and delayed breast reconstruction (DBR), according to age and body mass index. Early and late complications were compared between both groups after a minimum follow-up of 3 years. The need for corrective procedures on the reconstructed and contralateral breast was also evaluated. Data were collected using patients' medical records.

Results: A total of 20 patients who underwent IR with PMRT were identified and matched to 40 patients who underwent DBR. There were two revisions in the DR group, both due to venous occlusion. Both revisions were successful and no flap failures occurred in either group. The rate of early complications did not differ significantly between the two groups. Among late complications were both the rates of fat necrosis (p < 0.001) and skin contracture (p < 0.001) higher in the IBR group than in the DBR group. Neither corrective procedures to the reconstructed breast nor symmetrizing operations in the contralateral breast, differed between the groups.

Conclusion: The current study indicates that radiotherapy may contribute to adverse long-term flap-related outcome after IBR. We therefore recommend reconstructions to be delayed whenever possible in patients who will require PMRT.