Impact of radiation on conversion from implant-based to deep inferior epigastric perforator flap reconstruction

The deep inferior epigastric perforator (DIEP) flap is a reliable salvage option following complications of implant-based breast reconstruction (IBR). However, comparative data on indications and outcomes between radiated and non-radiated breasts remain limited.

A ten-year retrospective cohort study was performed by including patients who underwent DIEP flap reconstruction following complicated IBR. Data were compared between radiated and non-radiated breasts using the Mann-Whitney U, Chi-square, and Fisher's exact tests.

Among the 1684 patients who underwent IBR, 620 (36.8%) required implant removal or exchange, and 63 (3.7%) ultimately underwent DIEP flap reconstruction. In total, 89 breasts underwent DIEP reconstruction after complications of implant, among which 33 (37%) had received post-mastectomy radiation to the ipsilateral implant or tissue expander. Radiated breasts had higher rates of infection (25% vs. 7%, p = 0.02) and implant removal (34.4% vs. 7%, p = 0.002) rates prior to DIEP conversion. The median interval between mastectomy and DIEP reconstruction tended to be shorter in radiated breasts (28 vs. 39 months, p = 0.09). Capsular contracture was the most common indication for conversion (46.9% radiated vs. 29.8% non-radiated, p = 0.1). Flap survival was 100% in radiated breasts and 96.5% in non-radiated breasts (p = 0.53).

Permanent implant-to-DIEP conversion occurred in 3.7% of patients. Radiated breasts were more likely to experience infection and implant removal before conversion. Although the time to DIEP tended to be shorter in radiated patients, this was not statistically significant. DIEP flap reconstruction provides high survival in both groups, confirming its reliability as a salvage option.