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A Systematic Review of Morbidity Associated with Autologous Breast Reconstruction Before and After Exposure to Radiotherapy: Are Current Practices Ideal?

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The specific aim of this study was to conduct a systematic review of the literature to assess outcomes data on complications and aesthetic results associated with autologous tissue–based breast reconstruction performed before or after chest wall irradiation.

Methods

Studies from a PubMed search that met predetermined inclusion criteria were identified. Complications of interest included partial or total flap loss, fat necrosis, thrombosis, infection, seroma, hematoma, delayed wound healing, and flap fibrosis/contracture. Pooled complication rates were calculated.

Results

A total of 20 articles were included in the study for autologous reconstruction. These primary articles were selected after screening 897 publications, with six studies presenting data on pre-reconstruction radiation, nine studies presenting data on post-reconstruction radiation, and five studies presenting data on both patient groups. Comparison of pooled complication rates between flaps irradiated before or after reconstruction were statistically similar, including total flap loss (1 vs. 4 %), wound healing complications (10 vs. 14 %), infection (4 vs. 6 %), hematoma (2 vs. 1 %), seroma (4 vs. 4 %), and fat necrosis (10 vs. 13 %). The pooled rate of flap contracture and fibrosis was 27 % in flap reconstructions exposed to radiotherapy. Statistical evaluation of aesthetic outcomes was impossible as a result of variability in assessment and reporting methods.

Conclusions

Review of the current literature suggests similar rates of complications and success rates in autologous breast reconstruction patients exposed to pre- or post-reconstruction radiation. Immediate autologous reconstruction should be considered as a viable option even in patients who are likely to require postmastectomy radiotherapy.

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Acknowledgment

Support for this study was provided in part by grants from the Plastic Surgery Foundation (to AOM) and by a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) (to KCC).

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA

    Brian P. Kelley MD, Raouf Ahmed BSc Hons, Jeffrey H. Kozlow MD, MS, Kevin C. Chung MD, MS & Adeyiza O. Momoh MD

  2. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Kelley M. Kidwell PhD

Authors
  1. Brian P. Kelley MD
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  2. Raouf Ahmed BSc Hons
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  3. Kelley M. Kidwell PhD
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  4. Jeffrey H. Kozlow MD, MS
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  5. Kevin C. Chung MD, MS
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  6. Adeyiza O. Momoh MD
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Corresponding author

Correspondence to Adeyiza O. Momoh MD.

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Kelley, B.P., Ahmed, R., Kidwell, K.M. et al. A Systematic Review of Morbidity Associated with Autologous Breast Reconstruction Before and After Exposure to Radiotherapy: Are Current Practices Ideal?. Ann Surg Oncol 21, 1732–1738 (2014). https://doi.org/10.1245/s10434-014-3494-z

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  • DOI: https://doi.org/10.1245/s10434-014-3494-z

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