71487 - The role of previous implant-based breast reconstruction and radiotherapy for surgical complications in DIEP breast reconstruction

Abstract Introduction A deep inferior epigastric perforator (DIEP) flap breast reconstruction can be performed de novo or after a previous implant-based breast reconstruction (IBR). Fibrotic changes and capsule development after IBR may increase challenges in microvascular surgery especially in patients with previous radiotherapy. We aimed to evaluate whether previous IBR is associated with increased surgical complication rates in DIEP breast reconstruction. Method This study included all patients undergoing DIEP flap breast reconstruction at a university hospital 2005-2022. Patients were divided into those with or without previous IBR, and then further into those with or without a history of radiotherapy. Main outcomes were 1) microvascular re-anastomosis during surgery and 2) total or partial flap necrosis within 30 days. Multivariable logistic regression analyses were adjusted for Body Mass Index, smoking status, and age. Result Overall, 516 women had received 577 DIEP flap breast reconstructions. Partial necrosis occurred in 25 (4.3%) cases and total necrosis in 5 (0.9%) cases. Radiotherapy had been received prior to 446 reconstructions (77.3%) and in 213 (36.9%), an IBR had previously been performed. In irradiated patients, re-anastomosis and flap necrosis were significantly more common in those with a IBR (25/170 (14.7%) and 12/170 (7.1%), than those without a previous IBR (20/271 (7.4%) and 9/271 (3.3%); p=0.013 and 0.073, respectively). Discussion Previous IBR increased the risk of perioperative re-anastomosis but not of flap necrosis among previously irradiated patients. Although re-reconstruction using a DIEP flap can thus be considered safe despite previous radiotherapy and IBR, surgeons should acknowledge an increased perioperative complexity.