Can Patients Safely Undergo Short-Interval Free Autologous Breast Reconstruction (SIBT) after Adjuvant Radiation Therapy?

Introduction: The need for post mastectomy radiation therapy (PMRT) is a foundational component of multimodal breast cancer treatment for locally advanced disease. Patients undergoing PMRT have been offered delayed or delayed immediate autologous reconstruction 6-9 months after radiation. However, this delays the reconstruction process, often leads to unfavorable cosmetic outcomes, and has high complication rates. This study evaluated the feasibility and safety of performing autologous breast reconstruction within a 2–4-week interval after PMRT.

Methods: Between April to November 2024, patients who underwent PMRT followed by DIEP flap breast reconstruction within 3 weeks after PMRT were retrospectively identified and analyzed. The primary outcome was complete autologous flap loss. Demographic, treatment, and outcomes data were collected. 

Results: Three patients were identified. All patients underwent DIEP flap breast reconstruction at an average of 19.7 days (range: 17-21 days) after PMRT. The patients had no intra or postoperative complications. Intraoperatively, the patients’ recipient internal mammary vessels were found to be clinically indistinguishable from virgin vessels without any evidence of radiation damage. Both the surgeon and patient were satisfied with their results, with an average postoperative BREAST-Q breast satisfaction score of 87, psychosocial well-being score of 73.5, and sexual well-being score of 62.5.

Conclusion: Short-interval free autologous breast reconstruction (SIBT) after PMRT was successful and safe in this patient series. This strategy streamlines the reconstructive process, minimizes patient discomfort, and expedites the overall reconstruction timeline for breast cancer patients undergoing adjuvant radiation without exposing the flap to any untoward radiation induced sequela.