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Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy: Evaluation of Quality of Life and Outcomes

Pont, Luis Parra, M.D.; Marcelli, Stefano, M.D.; Robustillo, Manuel, M.D.; Song, Dajiang, M.D.; Grandes, Daniel, M.D.; Martin, Marcos, M.D.; Iglesias, Israel, M.D.; Aso, Jorge, M.D.; Laloumet, Iñaki, M.D.; Díaz, Antonio J., M.D.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 681-690
doi: 10.1097/PRS.0000000000003664
Breast: Original Articles
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Background: The effects of postoperative radiotherapy on free flap–based breast reconstruction are still controversial. Poor outcomes, breast distortion, and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction, and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap.

Methods: Between January of 2013 and December of 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors’ institution. Patients were divided into two groups depending on whether they received postmastectomy radiotherapy. Quality of life measured with the BREAST-Q questionnaire, self-reported aesthetic outcomes, and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity were also analyzed as the main surgical outcomes.

Results: Mean follow-up time after reconstruction was 23 months (range, 6 to 48 months). No significant difference in quality of life or satisfaction scores were found between patients that underwent postmastectomy radiotherapy and patients who did not receive adjuvant radiotherapy. There were no significant differences in rates of fat necrosis between the groups (11.1 percent versus 13.76 percent; p = 0.75).

Conclusions: Postmastectomy radiotherapy in patients undergoing immediate breast reconstruction with free flaps does not seem to affect quality of life, satisfaction with the outcome, or the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Madrid, Spain; Milan, Italy; and Changsha, Hunan, People’s Republic of China

From the Plastic Surgery Department, Hospital 12 de Octubre; Medico-Chirurgo-Scuola di Specializzazione in Chirurgia Plastica, Ricostruttiva ed Estetica Università degli Studi di Milano; and the Department of Oncology, Plastic Surgery, Hunan Province Cancer Hospital and the affiliated Cancer Hospital of Xiangya School of Medicine, Central South University.

Received for publication December 21, 2016; accepted March 23, 2017.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Luis Parra Pont, M.D., Hospital 12 de Octubre, Avenida de Andalucia s/n, 28041, Madrid, Spain, luis@parra.com.es

Copyright © 2017 by the American Society of Plastic Surgeons