Delayed breast reconstruction is best for women requiring radiotherapy

Radiotherapy may partly account for adverse long-term flap-related outcomes following immediate breast reconstruction (IBR), a recent study has shown.

Researchers retrospectively assessed 1,247 women who underwent autologous breast reconstruction between August 1997 and October 2013. Patients who received IBR with postmastectomy radiotherapy (PMRT; n=20; mean age, 46.25 years) were matched to two others who opted for delayed breast reconstruction (DBR) after PMRT (n=40; mean age, 46.08 years). Outcomes included early and late complications.

There were two cases of flap revision, both occurring in DBR group. These were ultimately successful, such that no flap failures were reported for either group. The incidence rates of early complications were comparable between the DBR and IBR arms.

In terms of long-term complications, 60 percent (n=12) of the IBR group developed contractures. In comparison, only 2.5 percent of the DBR group experienced fibrosis. The resulting between-group difference was significant (p<0.001).

A similar trend was reported for fat necrosis, which occurred in 60 percent of the IBR group and in only 12.5 percent of the DBR group (p<0.001).

“[W]hen the intent is to provide curative treatment, the choice between IBR and DBR is often determined by the need for PMRT,” the researchers explained. “Due to the adverse effects of radiotherapy on the reconstruction, the consensus is to postpone the reconstruction until after completion of adjuvant radiotherapy.”

Moreover, even in cases where patients specifically request for immediate reconstruction, clinicians should nevertheless inform them of the associated risks of the procedure, they added.