Radiation and Reconstructive Failure: Long-Term Outcomes in Two-Stage Flap Versus Implant Breast Reconstruction

Area of Science:

• Oncology
• Plastic Surgery
• Reconstructive Surgery

Background:

• Long-term risks of reconstructive failure after two-stage flap or implant reconstruction with radiation are not well-defined.
• Patient-reported outcomes (PROs) in this population require further investigation.

Purpose of the Study:

• To assess the risk of reconstructive failure in patients undergoing two-stage flap or implant reconstruction with radiation.
• To evaluate patient-reported outcomes (PROs) after these reconstructive procedures.

Main Methods:

• Analysis of 1210 patients undergoing two-stage reconstruction and radiation (2017-2023).
• Reconstructive failure defined as loss of tissue expander, implant, flap, or conversion from implant to flap.
• PROs assessed using BREAST-Q; failure predictors identified using Cox models and Kaplan-Meier curves.

Main Results:

• Reconstructive failure occurred in 13% of patients (89/930 implant vs. 3/215 flap).
• Predicted 72-month failure rates were 12% for implant and 1.4% for flap reconstruction.
• Implant reconstruction was associated with 7.5 times higher failure risk (HR: 7.5); flap reconstruction yielded higher 3-year BREAST-Q satisfaction scores.

Conclusions:

• Implant reconstruction following radiation therapy is linked to increased long-term failure risk and diminished patient-reported outcomes.
• Enhanced patient counseling regarding the risks and quality-of-life implications of implant reconstruction in the context of radiation is crucial.