Influence of radiation therapy on the development of complications in single-stage autologous breast reconstruction with a DIEP-flap in breast cancer patients: a retrospective study

Abstract

Breast reconstruction after complex oncological treatment is an urgent issue due to the high incidence of breast cancer.
 Aim. To analyze the effect of postoperative radiotherapy on the incidence of fat necrosis in single-stage autologous breast reconstruction with a DIEP flap and to evaluate the number of complications in groups with and without postoperative radiotherapy, as well as to determine the risk factors for complications.
 Materials and methods. The medical records of 34 breast cancer patients who underwent one-stage breast reconstruction using a DIEP flap after skin-sparing/subcutaneous mastectomy with and without subsequent radiation therapy were retrospectively studied. The frequency of complications in groups with and without postoperative radiation therapy was assessed.
 Results. Complications developed in 22 (64.7%) patients out of 34. Mild complications developed in 6 (17.6%) patients (divergence of the edges of the postoperative wound of the anterior abdominal wall). Complications of moderate severity developed in 12 (35.3%) patients. Severe complications developed in 4 (11.8%) patients. Out of 22 patients, 6 (17.4%) patients developed areas of fat necrosis after remote radiation therapy in the delayed period, 4 (11.8%) patients, without ESWL, also developed fat necrosis of a part of the flap (areas up to 5 cm). Excision of the area of fat necrosis of the flap was performed in 2 (5.9%) cases under local anesthesia, the rest of the areas of fat necrosis were not excised. The percentage of complications was higher in the group of patients with obesity (20.6%), which indicates that obesity is a risk factor for the development of intraoperative and postoperative complications in patients with simultaneous breast reconstruction with a DIEP flap.
 Conclusion. During radiotherapy after breast reconstruction with a DIEP flap, the incidence of fat necrosis of the flap was higher. Obesity is a risk of intraoperative and postoperative complications in patients with simultaneous increased breast reconstruction with a DIEP flap, since the incidence of complications was in the group of patients with obesity.