Related Experiment Video
Updated: May 22, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Less reconstruction failure in autologous over implant-based breast reconstructions in patients with a history of
Sophie H Nelissen1,2, Rami Elmorsi2, Mark V Schaverien2
1. Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Introduction:
An increasing number of women present for mastectomy and reconstruction following prior lumpectomy and irradiation, also known as breast-conserving therapy (BCT). While reconstruction after postmastectomy radiotherapy is well studied, outcomes following prior BCT remain less clearly defined. This study aimed to compare reconstructive outcomes in patients with a history of BCT.
Methods:
A retrospective review of patients with autologous or implant-based reconstructions with a history of BCT between January 2017 and March 2025 was performed. Patients were compared with radiation-naïve controls and reconstructive outcomes were compared. Propensity score matching was used to minimize selection bias. Complications were categorized as major, minor, or any complication.
Results:
In the matched autologous cohort, 50 BCT patients were matched to 200 radiation-naïve patients; those with prior BCT experienced higher rates of any complication (36.0% vs 20.0%, p=0.02), mainly caused by higher infection (8.0% vs 3.0%, p=0.2) and mastectomy skin flap necrosis (10.0% vs 3.5%, 0.07). In the matched implant-based cohort (49 BCT, 490 radiation-naïve), patients with prior BCT experienced significantly higher rates for major, minor and any complications (all p≤0.001). When comparing autologous BCT to implant-based BCT (45 matched in each), autologous reconstruction experienced lower rates of reconstruction failure (2.2% vs 24.4%, p<0.001). Other complications were comparable.
Conclusion:
A history of BCT is associated with increased postoperative complications following breast reconstruction, particularly in implant-based reconstructions. Autologous reconstruction offers lower failure rates in this population and should be strongly considered when feasible.
