title: Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes.
abstract: BACKGROUND
  In women who require postmastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. The authors prospectively evaluated postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy.
  
  
  METHODS
  Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium study, who received postmastectomy radiotherapy and underwent immediate or delayed free abdominally based autologous breast reconstruction, were identified. Postoperative complications at 1 and 2 years after reconstruction were assessed. Patient-reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively and at 1 and 2 years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes.
  
  
  RESULTS
  A total of 175 patients met the authors' inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients; 93.5 percent of immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9 percent immediate and 26.9 percent delayed at 1 year; p = 0.54). Patients with delayed reconstruction reported significantly lower prereconstruction scores (p < 0.0001) for Satisfaction with Breasts and Psychosocial and Sexual Well-being than did patients with immediate reconstruction. At 1 and 2 years postoperatively, both groups reported comparable levels of satisfaction in assessed BREAST-Q domains.
  
  
  CONCLUSIONS
  From this prospective cohort, immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient's perspective, were not compromised by flap exposure to radiation therapy.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Jessica
authors.initials: J
authors.lastname: Billig
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Ji
authors.initials: J
authors.lastname: Qi
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hamill
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Hyungjin M
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Edward
authors.initials: E
authors.lastname: Buchel
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
authors.affiliation: Ann Arbor, Mich.; New York, N.Y.; and Winnipeg, Manitoba, Canada.|From the Section of Plastic Surgery and the Departments of Radiation Oncology and Biostatistics, University of Michigan; the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Adeyiza O
authors.initials: AO
authors.lastname: Momoh
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D061214:Patient Safety / Q000706:statistics & numerical data*; D018579:Patient Selection; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013997:Time Factors; D015626:Tissue Expansion; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome