The AAPS 101st Annual Meeting

Radiate the Flap or Expander? The Impact of Post-Mastectomy Radiation Timing on Overall Outcomes after Autologous Free Flap Breast Reconstruction

Nisha Parmeshwar MD*, Laura Barnes MD, Catherine Nicholas BS, Scott Hansen MD, Merisa Piper MD

Background

•Post-Mastectomy Radiation Therapy (PMRT) decreases locoregional recurrence and improves overall survival for certain breast cancer patients

•Timing of radiation in autologous reconstruction patients is debated, either PRE or POST Flap

•PreFlap= Radiation BEFORE free flap àflap not radiated

•PostFlap= Radiation AFTER free flap àflap radiated

ØAIM: Evaluate overall outcomes comparing PreFlap and PostFlap PMRT patients

Methods

•Retrospective review of free abdominally-based autologous breast reconstruction from 2004-2021 for PMRT patients

•Demographic, intra-operative, and post-operative variables evaluated and compared between cohorts

Results

•452 flaps identified, of which 82 underwent PMRT

•49 PreFlap (59.8%)

•33 PostFlap (40.2%)

•No significant differences in medical comorbidities, prior breast surgery, chemotherapy (adjuvant and/or neoadjuvant)

•No significant differences in free flap outcomes including thrombosis, venous congestion, flap loss, takeback, seroma, nipple necrosis, infection (p>0.05)

Discussion

•Timing of PMRT did not impact free flap outcomes, including fat necrosis

•PreFlap PMRT patients experienced significantly more complications overall, likely due to tissue expander

•No difference in number of revision procedures including fat grafting for asymmetry (surrogate for shrinkage/deformities)

•Increased time to final reconstructive outcome including any revisions in PreFlap PMRT

•PostFlap PMRT may improve the overall patient experience, and decrease time to final outcome for the patient

Future Directions

ØIncreased sample size

ØMulti-institution prospective trial randomizing patients to PreFlap or Post Flap radiation protocol

The AAPS 101st Annual Meeting

Radiate The Flap Or Expander? The Impact Of Post-Mastectomy Radiation Timing On Overall Outcomes After Autologous Free Flap Breast Reconstruction

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