Background Postmastectomy radiation therapy (PMRT) decreases loco-regional recurrence and improves survival in patients with locally advanced breast cancer. Autologous free flap reconstruction, while more durable in the setting of radiation than alloplastic reconstruction, is still susceptible to radiation-induced fibrosis, contracture, fat necrosis, volume loss, and distortion of breast shape. Options for reconstruction timing (immediate vs. delayed) have been discussed to mitigate these effects, but a clear optimum is not known. Methods A systematic review of the literature was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using search terms “breast reconstruction AND (radiation OR irradiation OR radiotherapy)” were used. Inclusion criteria consisted of studies reporting complications for free flap breast reconstruction in the setting of PMRT. Patients who underwent PMRT were pooled into two groups: those who underwent immediate free flap reconstruction prior to PMRT and those who underwent delayed reconstruction after PMRT. Results Out of the 23 studies, 12 focused on immediate reconstruction, seven focused on delayed reconstruction, and four studies included both groups. Overall, 729 patients underwent immediate reconstruction, while 868 underwent delayed reconstruction. Complete and partial flap loss rates were significantly higher in patients undergoing delayed reconstruction, while infection and wound-healing complication rates were higher in those undergoing immediate reconstructions. Rates of unplanned reoperations, vascular complications, hematoma/seroma, and fat necrosis did not differ significantly between the two groups. However, rates of planned revision surgeries were higher in the delayed reconstruction group. Conclusion Immediate free flap breast reconstruction is associated with superior flap survival compared with delayed reconstruction. Rates of complications are largely comparable, and rates of revision surgeries are equivalent. The differences in long-term aesthetic outcomes are not, however, clearly assessed by the available literature. Even in the face of PMRT, immediate free flap breast reconstruction is an effective approach.

Background: Scholarly output has typically been measured by citation-based metrics such as the Hirsch index (h-index). The Altmetric Attention Score has emerged as a substitute to measure digital attention given to a project. This study aims to determine whether there is any correlation between h-index and the Altmetric score in the plastic surgery literature. Methods: Article metrics (full-text views, abstract views, PDF downloads, times e-mailed, Altmetric Attention Score, times tweeted, and number of citations by posts) were extracted from articles published in Plastic and Reconstructive Surgery over a 2-year period. Author metrics, including h5-index, were also collected. Pairwise correlations were performed using Spearman’s rank correlation coefficient (r). Results: A total of 1668 articles were published, with 971 included. Altmetric Attention Scores showed strong correlation with other article metrics (r = 0.48 to 0.97; p < 0.001) but weak correlation with h5-index (r = 0.14; p < 0.001) and sum of times cited without self-citation (r = 0.14; p < 0.001). It did not correlate with total publications, average citations per item, or sum of times cited. The h5-indexes showed strong positive correlation with other author bibliometrics (r = 0.66 to 0.97; p < 0.001); moderate correlation with times e-mailed (r = 0.41; p < 0.001); weak correlation with number of citations by posts (r = 0.10; p = 0.002); and no correlation with full-text views, abstract views, PDF downloads, and times tweeted. Conclusion: The Altmetric Attention Score and conventional senior author bibliometrics have weak positive correlation at best and appear to have distinct but complementary roles in measuring scholarly output.

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