Impact of Prior Implant-Based Reconstruction and Radiotherapy on Microvascular Outcome in Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

IF 3.6 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2026-10-12 DOI:10.1097/PRS.0000000000013522

Yihang Liu, Stina Rittri, Anna L V Johansson, Åsa Edsander Nord, Helena Sackey, Jana de Boniface, Martin Halle

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引用次数: 0

Abstract

Background: Delayed deep inferior epigastric perforator (DIEP) flap breast reconstruction can be performed after either mastectomy alone or implant-based reconstruction (IBR). Fibrosis and capsular contracture after IBR are more pronounced in patients exposed to radiotherapy (RT). We evaluated whether a previous IBR increases microvascular complication rates in delayed DIEP reconstruction in patients exposed to RT.

Methods: All patients undergoing delayed DIEP reconstruction for breast cancer at a tertiary referral hospital (2005-2022) were included. Patients were categorized by history of IBR and RT. Primary outcomes were 1) perioperative microvascular re-anastomosis and 2) flap necrosis within 30 days. Logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) adjusted for age, body mass index, and smoking.

Results: In total, 516 women underwent 577 DIEP reconstructions; 213 (36.9%) had a previous IBR, 441 (77.3%) had received RT, and 170 (38.5%) had both IBR and RT. Perioperative re-anastomosis was more frequent after a previous IBR than after mastectomy alone among irradiated patients (14.7% vs. 7.4%, p=0.013). Rates of flap necrosis (partial or total) did not differ across the groups. Among irradiated patients, IBR was associated with an almost twofold increased risk of re-anastomosis compared with patients without prior IBR (OR 1.98, 95% CI 1.04-3.76). In contrast, previous IBR was not associated with flap necrosis (OR 2.17, 95% CI 0.84-5.62). Vein coupler size was smaller in irradiated than non-irradiated patients (2.03± 1.03 vs. 2.32 ± 0.89 mm, p<0.001).

Conclusions: Among irradiated patients, previous IBR was associated with an increased frequency of perioperative arterial re-anastomosis but not flap loss. DIEP reconstruction remains safe in this setting, though surgeons should anticipate increased perioperative complexity.

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术前植体重建及放疗对上腹部深下穿支皮瓣乳房重建微血管预后的影响。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.