A Comparative Analysis Of Long-term Surgical Outcomes Of Delayed-immediate Versus Delayed Autologous Breast Reconstruction With And Without Postmastectomy Radiotherapy
Abbas M. Hassan, MD, Praneet Paidisetty, BS, Janhavi G. Govande, BS, Nicholas Ray, BS, Rene D. Largo, MD, Carrie K. Chu, MD, Alexander F. Mericli, MD, Mark V. Schaverien, MS, Mark W. Clemens, MD, Matthew M. Hanasono, MD, Edward I. Chang, MD, Jesse C. Selber, MD.
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE: Delayed-immediate breast reconstruction is often preferred in the setting of postmastectomy radiotherapy (PMRT) to allow for mastectomy skin preservation. The long-term outcomes of this approach, particularly when compared to delayed reconstruction, are not well established. In this study, we compared the outcomes of delayed-immediate and delayed reconstruction with and without PMRT.
METHODS: We conducted a retrospective cohort study of consecutive patients who underwent mastectomy and microvascular breast reconstruction followed by PMRT from January 2016 to April 2022. Primary outcome was any breast-related complication. Secondary outcomes were 30-day readmission and reoperation.
RESULTS: We identified 1002 reconstructions (672 delayed; 330 delayed-immediate) with a mean follow-up of 24.0±19.3 months. PMRT was required in 56.3% (n=564) of reconstructions. In the non-PMRT group, we found no significant difference in rates of any breast-related complication (26.2% vs. 21.4%, p=0.244), 30-day readmission (9.3% vs. 5.5%, p=0.132), or reoperation (8.4% vs. 6.5%, p=0.078) between delayed and delayed-immediate reconstructions. In the PMRT group, we found no difference in rates of any breast-related complication (25.1% vs. 22.5%, p=0.550), or reoperation (10.6% vs. 5.4%, p=0.078) between delayed and delayed-immediate reconstructions; however, the rates of infection (10.3% vs. 3.9%, p=0.023) and 30-day readmission (14.7% vs. 4.7%, p=0.002) were higher in the delayed reconstruction group. In multivariable regression, delayed reconstruction with PMRT was associated with a 3-fold higher risk of readmission (OR,2.93; p=0.019).
CONCLUSION: Delayed-immediate reconstruction provides safe long-term outcomes comparable with delayed reconstruction. In those requiring PMRT, delayed reconstruction is associated with higher infection rates and a higher risk of readmission.
Back to 2023 Abstracts