Impact of Prior Implant-Based Reconstruction and Radiotherapy on Microvascular Outcome in Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

Authors

Yihang Liu, Stina Rittri, Anna L V Johansson, Åsa Edsander Nord, Helena Sackey, Jana de Boniface, Martin Halle

Published in

Plastic and reconstructive surgery. Oct 12, 2026. Epub Oct 12, 2026.

Abstract

Delayed deep inferior epigastric perforator (DIEP) flap breast reconstruction can be performed after either mastectomy alone or implant-based reconstruction (IBR). Fibrosis and capsular contracture after IBR are more pronounced in patients exposed to radiotherapy (RT). We evaluated whether a previous IBR increases microvascular complication rates in delayed DIEP reconstruction in patients exposed to RT.
All patients undergoing delayed DIEP reconstruction for breast cancer at a tertiary referral hospital (2005-2022) were included. Patients were categorized by history of IBR and RT. Primary outcomes were 1) perioperative microvascular re-anastomosis and 2) flap necrosis within 30 days. Logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) adjusted for age, body mass index, and smoking.
In total, 516 women underwent 577 DIEP reconstructions; 213 (36.9%) had a previous IBR, 441 (77.3%) had received RT, and 170 (38.5%) had both IBR and RT. Perioperative re-anastomosis was more frequent after a previous IBR than after mastectomy alone among irradiated patients (14.7% vs. 7.4%, p=0.013). Rates of flap necrosis (partial or total) did not differ across the groups. Among irradiated patients, IBR was associated with an almost twofold increased risk of re-anastomosis compared with patients without prior IBR (OR 1.98, 95% CI 1.04-3.76). In contrast, previous IBR was not associated with flap necrosis (OR 2.17, 95% CI 0.84-5.62). Vein coupler size was smaller in irradiated than non-irradiated patients (2.03± 1.03 vs. 2.32 ± 0.89 mm, p<0.001).
Among irradiated patients, previous IBR was associated with an increased frequency of perioperative arterial re-anastomosis but not flap loss. DIEP reconstruction remains safe in this setting, though surgeons should anticipate increased perioperative complexity.

PMID:
42862123
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

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