An Analysis of the Timing of Autologous Breast Reconstruction After Mastectomy and Radiotherapy

Autologous breast reconstruction (ABR) following postmastectomy radiotherapy (PMRT) is often delayed several months due to adverse effects of radiation on outcomes. The optimal time between PMRT and ABR remains uncertain. We sought to analyze how the timing of ABR following PMRT affects postoperative outcomes.

A retrospective analysis was performed on adult female patients who underwent ABR. Cases were analyzed on a per-flap basis and were stratified into PMRT and non-PMRT groups. The PMRT group was further stratified into cohorts based on the time from completion of PMRT to ABR defined as: 0-3 months, 3-6 months, 6-12 months, and 12+ months. Primary outcomes included flap failure or necrosis and immediate reoperation. All other complications were secondary outcomes. Group differences were assessed using Chi-squared, Fischer's exact, Kruskal-Wallis and Wilcoxon rank sum tests. A logistic mixed-effects model was conducted to identify variables associated with postoperative complications.

514 flaps among 339 patients were included. 37.2% of the flaps were performed following PMRT: 5 within 0-3 months, 72 within 3-6 months, 71 within 6-12 months, and 43 within 12+ months. There were no statistically significant differences in reoperations, flap thrombosis, flap failure, infection, wound dehiscence, or operative time when comparing cases with or without PMRT and no statistically significant differences when comparing cases at the various time intervals.

No statistically significant differences in postoperative complications were observed across PMRT timing intervals. These findings do not support a strong association between the interval from radiotherapy to ABR and complication rates.