The impact of autologous breast reconstruction using DIEP flap on the oncologic efficacy of radiation therapy

Abstract

In the management of breast cancer radiation therapy plays a substantive role in decreasing local recurrence and increasing overall survival. Still, there exists controversy concerning compromised radiation delivery plans and suboptimal delivery after immediate autologous breast reconstruction. Our study aims to assess the oncologic safety of immediate breast reconstruction (IBR) with a Deep inferior epigastric perforator flap (DIEP), in the setting of adjuvant radiation therapy. We conducted a retrospective analysis using a prospectively maintained database of all consecutive women undergoing breast reconstruction with a DIEP flap in the setting of radiation therapy. Independent variables included patient age, cancer stage, tumor grade type and subtype, adjuvant and neoadjuvant chemotherapy, hormonal therapy, diabetes mellitus, and tobacco use. Main outcome variables were: local recurrence, distant metastasis, patient demise and total flap failure. From July 2008 to January 2014, and out of 450 patients who underwent reconstruction with a DIEP flap, 62 were considered eligible. Thirty patients (48%) had IBR followed by radiation therapy and 32 (52%) had delayed reconstruction preceded by radiation therapy. The two groups were comparable with respect to the independent variables. Local recurrence occurred in 3.2% of patients; 3.3% in the immediate group and 3.1% in the delayed (P=0.963). Distant metastasis occurred in 6.4% of patients: 10% in the immediate group and 3.1% in the delayed (P=0.27). Breast cancer related mortality occurred in 4.8%: 6.7% in the immediate group and 3.1% in the delayed (P=0.52). Immediate reconstruction with a DIEP flap in the setting of adjuvant radiation therapy is an acceptable approach and appears not to influence the oncologic efficacy of radiation treatment. Further prospective studies are advocated.