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Published on: May 17, 2024
Postmastectomy Radiation Therapy on Flap Outcomes in Breast Reconstruction: A Systematic Review and Meta-analysis
Fatima Alameri1, Anne-Sophie Reguesse1, Pierre Tawa1
1From the Department of Plastic Surgery, Paris Saint-Joseph Hospital, Paris, France.
Plastic and Reconstructive Surgery. Global Open
|May 27, 2026
Summary
Delayed breast reconstruction after postmastectomy radiation therapy (PMRT) offers better outcomes. While immediate reconstruction shows higher complication rates, delayed methods improve cosmetic results and reduce issues like fat necrosis.
Area of Science:
- Plastic Surgery
- Oncology
- Radiotherapy
Background:
- Breast reconstruction is crucial for mastectomy patients.
- Postmastectomy radiation therapy (PMRT) can negatively impact flap perfusion and cosmetic outcomes.
- Comparisons between irradiated and non-irradiated flaps are essential for immediate and delayed reconstruction.
Purpose of the Study:
- To systematically compare irradiated and non-irradiated flaps in breast reconstruction.
- To evaluate flap viability, complication rates, aesthetic outcomes, and patient satisfaction.
- To analyze the impact of immediate versus delayed reconstruction in the context of PMRT.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched PubMed and Cochrane Library (2000-2024).
- Included studies comparing flap viability, complications, aesthetics, or satisfaction; used fixed- and random-effects models.
Main Results:
- Flaps receiving irradiation, especially in immediate reconstructions, showed higher complication rates (e.g., fat necrosis, contracture).
- Delayed reconstruction post-PMRT had lower complication rates and favorable outcomes; flap survival was similar for immediate and delayed.
- Deep inferior epigastric perforator flaps had less fat necrosis (≈12%) compared to TRAM (≈25%) and latissimus dorsi flaps (≈40%).
Conclusions:
- Immediate reconstruction post-PMRT is linked to increased postoperative complications and poorer aesthetic results.
- Delayed reconstruction demonstrates reduced complications and superior cosmetic outcomes.
- Flap-specific planning is vital for irradiated patients, with variations in complication rates among different flap types.