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Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes

Billig, Jessica M.D.; Jagsi, Reshma M.D., D.Phil.; Qi, Ji M.S.; Hamill, Jennifer B. M.P.H.; Kim, Hyungjin M. Sc.D.; Pusic, Andrea L. M.D., M.H.S.; Buchel, Edward M.D.; Wilkins, Edwin G. M.D., M.S.; Momoh, Adeyiza O. M.D.

Plastic and Reconstructive Surgery: June 2017 - Volume 139 - Issue 6 - p 1279-1288
doi: 10.1097/PRS.0000000000003331
Breast: Outcomes Articles

Background: In women who require postmastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. The authors prospectively evaluated postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy.

Methods: Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium study, who received postmastectomy radiotherapy and underwent immediate or delayed free abdominally based autologous breast reconstruction, were identified. Postoperative complications at 1 and 2 years after reconstruction were assessed. Patient-reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively and at 1 and 2 years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes.

Results: A total of 175 patients met the authors’ inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients; 93.5 percent of immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9 percent immediate and 26.9 percent delayed at 1 year; p = 0.54). Patients with delayed reconstruction reported significantly lower prereconstruction scores (p < 0.0001) for Satisfaction with Breasts and Psychosocial and Sexual Well-being than did patients with immediate reconstruction. At 1 and 2 years postoperatively, both groups reported comparable levels of satisfaction in assessed BREAST-Q domains.

Conclusions: From this prospective cohort, immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient’s perspective, were not compromised by flap exposure to radiation therapy.


Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada

From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.

Received for publication August 29, 2016; accepted November 15, 2016.

Presented at Plastic Surgery The Meeting, in Los Angeles, California, September 23 through 27, 2016.

Disclosure:Dr. Pusic is a co-developer of the BREAST-Q, which is owned by Memorial Sloan Kettering Cancer Center. She receives a portion of licensing fees (royalty payments) when the BREAST-Q is used in industry sponsored clinical trials. The remaining authors have no financial interest to disclose.

Adeyiza O. Momoh, M.D., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340,

Copyright © 2017 by the American Society of Plastic Surgeons