Postmastectomy Radiotherapy in Immediate Autologous Breast Reconstruction: A Patient-Reported and Clinical Outcomes Study

Background: Radiotherapy is routinely indicated in patients diagnosed with breast cancer, presenting a challenge in the immediate breast reconstruction setting. The authors compared and evaluated complications and aesthetic and patient-reported outcomes in patients undergoing immediate deep inferior epigastric artery (DIEP) flap reconstruction with postmastectomy radiotherapy (PMRT) or without PMRT (no PMRT). Methods: Prospective data collection was undertaken of all patients who underwent mastectomy and immediate DIEP flap breast reconstruction over a 3-year period and completed long-term follow-up. Patient demographics, comorbidities, oncologic treatments, surgical complications, and secondary procedures were recorded. Surgeon-reported aesthetic outcomes were assessed using standardized photographs, and patient-reported outcomes were evaluated using the BREAST-Q questionnaire. Results: The study included 108 patients (55 with no PMRT, 53 with PMRT) with 134 immediate DIEP flap breast reconstructions. Patients in the PMRT group were significantly younger and received a higher proportion of neoadjuvant and adjuvant chemotherapy. Major and minor surgical complications were similar. The rate of clinically significant fat necrosis was low and similar in both groups. Most patients underwent at least one further surgical episode to finalize the aesthetic outcome. The overall global score from the surgeon panel was high (no PMRT versus PMRT, 8.58 versus 8.17; P = 0.218). Overall patient satisfaction with outcome was similar between the groups (no PMRT versus PMRT, 87 versus 86), with a slight decrease in satisfaction with breasts (84 versus 76; P = 0.039) in the PMRT group. Conclusion: This study demonstrates immediate autologous breast reconstruction with PMRT to be safe, with satisfactory aesthetic and patient-reported outcomes.