title: Effects of radiation therapy for breast cancer based on type of free flap reconstruction.
abstract: BACKGROUND
  Adjuvant radiation therapy for locally advanced breast cancer decreases local recurrence and improves survival. Immediate autologous breast reconstruction before postmastectomy irradiation is highly controversial. However, it is presently unknown whether there exist differences in the durability of various autologous flaps (myocutaneous or fasciocutaneous) to the effects of radiation.
  
  
  METHODS
  All patients who underwent autologous breast reconstruction at the authors' institution between July of 2002 and July of 2005 were evaluated retrospectively. Patients who did not complete all stages of their reconstruction at the authors' institution were excluded. Free flap types were analyzed based on postoperative radiation exposure versus no radiation exposure. The authors also analyzed patients who underwent reconstruction in a delayed fashion with prior radiation exposure and assessed overall outcomes for early and late complications and secondary breast procedures.
  
  
  RESULTS
  Three hundred sixty-three of 446 flaps (81 percent) were included in the analysis, with the three most common flaps being the free transverse rectus abdominis myocutaneous (TRAM) flap (7.4 percent), the muscle-sparing free TRAM flap (44 percent), and the deep inferior epigastric perforator flap (41 percent). There were no significant differences in early or late complications among the different flap types or radiation categories. Flaps with prior radiation exposure were associated with higher percentages of contralateral symmetry procedures, whereas flaps with postoperative radiation exposure had a lower incidence of ipsilateral revisions.
  
  
  CONCLUSIONS
  Autologous breast reconstruction can be performed safely regardless of preoperative or postoperative radiation therapy. There are no significant differences in complication rates or number of revisions based on the type of free flap.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Los Angeles, Calif. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles Medical Center.
authors.forename: Eric I
authors.initials: EI
authors.lastname: Chang
authors.forename: Tom S
authors.initials: TS
authors.lastname: Liu
authors.forename: Jaco H
authors.initials: JH
authors.lastname: Festekjian
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Da Lio
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Crisera
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D061525:Perforator Flap / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D018714:Radiotherapy, Adjuvant; D017568:Rectus Abdominis / Q000637:transplantation; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome