Delayed autologous breast reconstruction after postmastectomy radiation therapy: is there an optimal time?

The optimal time for delayed autologous breast reconstruction after postmastectomy radiation therapy (PMRT) is unknown. Although most reconstructive surgeons recommend waiting for 6 months, this timing is arbitrary. A retrospective analysis was performed of 199 patients undergoing delayed autologous reconstruction; 100 patients had prior PMRT, whereas 99 patients had no previous radiation. Radiated patients had higher overall complications (40% vs. 20.2%, P = 0.0023), including wound dehiscence (11% vs. 3%, P = 0.049), and trended toward increased postsurgical infections (7% vs. 1%, P = 0.065). Logistic regression models of unequally distributed variables found radiation therapy to be the only independent risk factor for wound dehiscence (odds ratio, 3.97; P = 0.04). Mean follow-up for radiated and nonradiated patients was 33.3 months and 39.4 months, respectively. After PMRT, 17 patients were reconstructed within 6 months and 83 after 6 months. No significant differences in complications were observed between these groups. An alternate analysis examined 51 patients reconstructed within 12 months of PMRT and 49 patients reconstructed after; again, there were no differences in complications. As overall complications are similar in patients reconstructed early or late after PMRT, autologous breast reconstruction can potentially be performed earlier than is the current accepted practice.