Bilateral Free Flap Breast Reconstruction After Unilateral Radiation

Fracol, Megan; Basta, Marten N.; Nelson, Jonas A.; Fischer, John P.; Wu, Liza C.; Serletti, Joseph M.; Fosnot, Joshua

doi:10.1097/sap.0000000000000545

Cited by 45 publications

(30 citation statements)

References 20 publications

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“…Intraoperative vascular complications and postoperative wound infections have been shown to be significantly more likely to occur in the setting of autologous free flap reconstruction after PMRT, and it is felt that the timing of reconstruction may play a role. 29 A study by Baumann et al demonstrated that patients who underwent reconstruction at a minimum of 12 months from completion of PMRT developed fewer complications, including microvascular thrombosis and total flap loss, than those who underwent delayed reconstruction within 12 months of completing therapy. 30 However, other studies reveal that patients who undergo autologous reconstruction within versus after 12 months following PMRT have no significant differences in complications.…”

Section: Resultsmentioning

confidence: 99%

Breast Reconstruction and Radiation Therapy

2018

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Purpose:The optimal approach to the integration of postmastectomy reconstruction and radiation therapy is not well-established. This review will summarize current literature pertaining to the most common types of reconstruction in the setting of postmastectomy radiation therapy (PMRT).Data Sources:Literature from PubMed was reviewed from 2000 to 2016.Study Selection:Studies were selected with relevance to “postmastectomy breast reconstruction,” “breast reconstruction,” and “breast reconstructive methods and PMRT.” Surgical outcomes, patient satisfaction, and cost-effectiveness were examined.Data Extraction:Data from publications was extracted, summarized, and converted to a table.Results of Data Synthesis:Implant-based techniques are on the rise, in the setting of PMRT. Implant-based methods are more affordable in the short term and result in immediate breast-mound formation compared to autologous methods. When compared to implant-based reconstruction with PMRT, autologous reconstruction with PMRT results in better quality of life (QoL) and sensory recovery as well as fewer complications and failures. Among autologous flaps, deep inferior epigastric perforator flaps are considered superior to transverse rectus abdominal muscle (TRAM) pedicled flaps and may be more suitable for PMRT. Latissimus dorsi and muscle-sparing free TRAM flaps are also viable options. In delayed autologous, which may be advantageous for high-risk patients, the optimal timing to delay surgery after radiation therapy is unknown. Reconstruction with a 2-stage tissue expander-implant technique offers good to excellent cosmetic outcomes in the setting of PMRT, although there may be complications in this 2-stage process.Conclusion:Surgical, cosmetic, quality of life, and life expectancy must be taken into account when selecting the way to integrate breast reconstruction and PMRT.

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Section: Resultsmentioning

confidence: 99%

Breast Reconstruction and Radiation Therapy

2018

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“…8,9,28–38 With well documented concerns, the general consensus has been to approach immediate reconstruction in patients requiring PMRT with caution and delay flap reconstruction until after radiation therapy in order to optimize reconstructive results and decrease radiation-associated flap complications. 39 Over time, there has been a swell in the level of interest for immediate breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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

Billig

Jagsi

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background In women who require post-mastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. We aim to prospectively evaluate postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy. Methods Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium Study, who received post-mastectomy radiotherapy and had immediate or delayed free abdominal-based autologous breast reconstruction were identified. Postoperative complications at one and two years after reconstruction were assessed. Patient reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively, at one and two-years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes. Results A total of 175 patients met our inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients. 93.5% of the immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9% immediate and 26.9% delayed at one year; p=0.54). Patients with delayed reconstruction reported significantly lower pre-reconstruction scores (p<0.0001) for satisfaction with breast, psychosocial and sexual well-being than did patients with immediate reconstruction. At one and two years postoperatively, both groups of patients reported comparable levels of satisfaction in assessed BREAST-Q domains. Conclusions From this prospective cohort, immediate autologous breast reconstruction in the setting of post-mastectomy 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.

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“…Although indications for breast reconstruction are many, the significant factors are whether the reconstruction is immediate or delayed, 16 17 bilateral or unilateral, 18 in a radiated field, 19 20 or if there is a presence of an open wound. Bilateral reconstruction impacts the volume of tissue necessary and may require alternate donors if adequate tissue is not present to reconstruct two breasts.…”

Section: Flap Selectionmentioning

confidence: 99%

Microsurgical Breast Reconstruction: Maximizing Success

Buntic¹,

2022

Semin Plast Surg

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Breast reconstruction is becoming increasingly recognized as a fundamental component in comprehensive breast cancer treatment. The primary goal for any reconstruction is to safely restore a natural appearing breast. When it comes to achieving the elements of size, shape, symmetry, and softness, the use of autologous tissue has many advantages. The approach to autologous breast reconstruction has changed substantially over the years as microsurgical free tissue transplants become more routine and accessible. While a variety of flap donor sites exist, careful flap selection based on surgical history and the availability of donor tissue is critical in achieving reliable results. This article reviews the clinical considerations in patient evaluation, donor site selection, and surgical approach taken at the Buncke Clinic.

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Bilateral Free Flap Breast Reconstruction After Unilateral Radiation

Cited by 45 publications

References 20 publications

Breast Reconstruction and Radiation Therapy

Breast Reconstruction and Radiation Therapy

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

Microsurgical Breast Reconstruction: Maximizing Success

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