Abstract
BACKGROUND: The number of immediate breast reconstructions has significantly increased in recent years. Autologous breast reconstruction, in particular, offers superior long-term cosmetic outcomes and patient satisfaction. However, the effects of postmastectomy radiotherapy (PMRT) on autologous reconstructions remain a subject of debate. This study aims to evaluate the long-term outcomes of autologous breast reconstruction in patients who underwent PMRT compared to those who did not. METHODS: Patients who underwent mastectomy and immediate autologous reconstruction between 2018 and 2023 were prospectively followed for complications and patient-reported outcomes. Patients were categorized into two groups: those who received PMRT (n = 43) and those who did not (n = 59). Patient-reported outcomes were assessed using the BREAST-Q questionnaire, while complications were analyzed based on clinical records. Statistical analysis included logistic regression to identify factors associated with complications and patient satisfaction. RESULTS: The incidence of overall complications were significantly higher in the irradiated group (46.5%) compared to the unirradiated group (23.7%). PMRT was associated with a higher rate of fat necrosis (39.5% vs 8.5%) and flap fibrosis (9.3% vs 0%). The BREAST-Q scores for the physical well-being of the chest and satisfaction with breast reconstruction were significantly lower in the irradiated group. The psychosocial well-being scores did not differ between the two groups. Patients irradiated with the IMRT and VMAT techniques had lower complication rates and higher BREAST-Q scores compared to those treated with the 3D technique. CONCLUSION: While PMRT increases the risk of complications following autologous breast reconstruction, overall patient satisfaction remains high. The use of advanced radiotherapy techniques such as IMRT and VMAT may help mitigate some of the adverse effects associated with radiation therapy. Future research should focus on optimizing reconstruction techniques and refining patient selection criteria to enhance long-term outcomes.