The Impact of Preoperative Radiotherapy and Chemotherapy on Autologous Breast Reconstruction Outcomes

Article Article scientifique Article The Impact of Preoperative Radiotherapy and Chemotherapy on Autologous Breast Reconstruction Outcomes—A Retrospective Single-Center Study eng 2025-02-04 author Nava Caterina Maria 0009-0009-0210-6857 402688 author Martineau Jérôme author Dong Edward Tian Cheng 951333 Structure enseignement (ENSI) author Zinner Gauthier René Christian 0009-0007-8171-6746 840663 author Oranges Carlo 0000-0003-1735-5329 955344 Département de chirurgie (CHIRU) 512 10.3390/cancers17030512 39941879 2072-6694 PMC11817497 https://www.mdpi.com/2072-6694/17/3/512 Background: While radiotherapy (RT) and chemotherapy (CT) significantly improve breast cancer outcomes, they may affect breast reconstruction by causing vascular damage and delayed wound healing. This retrospective study evaluates how preoperative RT, CT, or the combination of both impacts intraoperative and postoperative outcomes in immediate or delayed deep inferior epigastric perforator (DIEP) flap breast reconstructions. Methods: We conducted a single-center review of all patients undergoing autologous DIEP flap reconstruction after mastectomy between 2018 and 2024. Patients were divided into four groups: RT only, CT only, a combination of RT and CT, and a control group with no preoperative therapies. Intraoperative and postoperative outcomes were then compared among these groups, with statistical significance defined as p < 0.05. Results: We included 114 patients representing 141 DIEP-flap breast reconstructions. Flap survival rate was 98.5%. In the univariate analysis, total microvascular recipient site complications were significantly higher in the RT + CT group (14.0%, p = 0.021). Donor-site complication rates differed significantly among the four groups (p = 0.025), with the highest rate observed in the RT + CT group (44.7%). In the logistic regression analysis, ischemia time was found as an independent risk factor for total recipient site complications, but not for microvascular complications (OR = 1.019, 95%-CI = 1.004-1.035, p = 0.014). Conclusions: Combined RT + CT significantly increased microsurgical complications. Ischemia time correlated with higher odds of total recipient site complications. Individualized patient management and diminished ischemia time are likely to improve flap survival. DIEP Autologous free flap Chemotherapy Microvascular Radiotherapy Dewey 617 57 Département de chirurgie 222 false Cancers 17 3 689acce4-ea50-4482-b5fd-42cf205d24f4 Article (Published version) Public Article_scientifique_from_crossref.pdf 579157 application/pdf CC BY-4.0 42a9258e53fa43bd189145f7d7f10fc52949c3c21e0e4681e49cbc59a843c6e7 openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

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The Impact of Preoperative Radiotherapy and Chemotherapy on Autologous Breast Reconstruction Outcomes—A Retrospective Single-Center Study	Cancers			2025	43	135

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Dong, Edward Tian Cheng