Bilateral free flap breast reconstruction after unilateral radiation comparing intraoperative vascular complications and postoperative outcomes in radiated versus nonradiated breasts

Megan E. Fracol, Marten N. Basta, Jonas A. Nelson, John P. Fischer, Liza C. Wu, Joseph M. Serletti, Joshua Fosnot*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Background: Radiation induces vessel damage and impairs tissue healing. To date, only 1 study has examined radiation's impact in autologous breast reconstruction on intraoperative vascular complications and postoperative outcomes. In this follow-up paper, we examine a larger cohort with an improved study design to better control for patient characteristics. Methods: A database of 1780 patientswho underwent autologous breast free flap reconstruction at the University of Pennsylvania's Health System between 2003 and 2014 was searched for patients who underwent bilateral breast reconstruction after unilateral radiation, returning 199 patients for review. These were then analyzed for intraoperative vascular complications aswell as postoperative complications. McNemar tests were performed on all variables, comparing between radiated and nonradiated fields. Results: Fields with prior radiation were significantly more likely to have any type of intraoperative vascular complication and need for arterial anastomotic revision compared to fields without prior radiation (14% versus 7%, P = 0.03 and 8% versus 3%, P = 0.04, respectively). Although there was a trend for more frequent arterial thrombosis in radiated compared to nonradiated fields, this was nonsignificant (7% versus 3%, P = 0.08). There was no significant difference in venous thrombosis or need for venous anastomotic revision. Radiated fields were significantly more likely to have postoperative wound infections compared to nonradiated fields (4% versus 0.5%, P = 0.04). There was no difference in other postoperative complications, including postoperative thrombosis, flap loss, mastectomy flap necrosis, fat necrosis, hematoma, seroma, or delayed wound healing. Conclusions: Intraoperative vascular complications and postoperative wound infections are significantly more likely to occur in autologous breast free flap reconstruction with previous radiation therapy. It is important to plan for and counsel patients that fields with previous radiation are at higher risk for these complications.

Original languageEnglish (US)
Pages (from-to)311-314
Number of pages4
JournalAnnals of plastic surgery
Volume76
Issue number3
DOIs
StatePublished - 2016

Keywords

  • Autologous breast reconstruction
  • Free flap breast reconstruction
  • Intraoperative complications
  • Postoperative complications
  • Radiation
  • Radiation-induced damage

ASJC Scopus subject areas

  • Surgery

Fingerprint

Dive into the research topics of 'Bilateral free flap breast reconstruction after unilateral radiation comparing intraoperative vascular complications and postoperative outcomes in radiated versus nonradiated breasts'. Together they form a unique fingerprint.

Cite this