Optimal Timing of Free Flap Breast Reconstruction in a Highly Radiated Population

Introduction There has been an increasing use of postmastectomy radiation therapy (PMRT) in breast cancer patients, especially in cases of large tumors (T3 or greater) or node-positive disease (N1 or greater).1 When radiation for the treatment of breast cancer is expected, tissue-based breast reconstruction is generally preferred to implant-based reconstruction. This distinction is attributed to the high rate of complications with postoperative radiation after implant-based reconstruction, ranging from 20% to 70%.2 In cases when the need for radiation is likely, breast reconstruction with autologous tissue is typically deferred until the completion of the radiation therapy. Reasons for deferring include avoiding additional morbidity that may delay adjuvant therapy, avoiding irradiating the flap, and maintaining a planar field to optimize radiation delivery.3-9 Additionally, radiation is known to cause tissue fibrosis, edema, and vasculitis, all of which can interfere with wound healing.3 These reasons must be balanced against the increased psychological discomfort of delayed breast reconstruction, as defect of the breast can affect a woman’s self-esteem.10 Few studies have examined the effects of prior radiotherapy on autologous breast reconstruction.11,12 The purpose of this study is to delineate the effects of postmastectomy radiation therapy on outcomes of lower abdominal free flap breast reconstruction by a single surgeon.https://jdc.jefferson.edu/surgeryposters/1006/thumbnail.jp