Outcomes of postmastectomy radiotherapy in immediate autologous versus implant-based breast reconstruction: a multi-institutional cohort study
In brief
After radiation, 29% of implant reconstructions failed; none of 68 flaps did
In this retrospective 113-patient cohort, reconstruction failure occurred in 13 of 45 implant-based cases after radiation, compared with none of 68 autologous flaps. Flap patients also had less significant firmness and more often good or excellent physician-rated cosmesis, but the comparison was not randomized and most implant cases were direct-to-implant procedures.
- Journal
- Breast cancer research and treatment (Q1)
- Published
- 20 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Shing Fung Lee, Lorenztino Admojo, Yuan-Hong Lin, Pui Lam Yip, Farshad Foroudi, Sunil Jassal, et al.
- PMID
- 42902044
- DOI
- 10.1007/s10549-026-08098-x
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 22 October 2026): Direct comparison of autologous and implant reconstruction after radiotherapy
Abstract
BACKGROUND: To compare late toxicities, cosmetic outcomes, and reconstruction failure in patients undergoing immediate autologous reconstruction (AR) versus implant-based reconstruction (IBR) followed by postmastectomy radiotherapy (PMRT). METHODS: A multi-institutional retrospective cohort study (2013-2024) assessed patients undergoing mastectomy with immediate reconstruction and PMRT. Primary endpoints were reconstruction failure (loss or replacement of the index implant reconstruction, or total flap loss) and late toxicities, including contracture, fat necrosis, and cosmesis (Kroll scale). RESULTS: 113 patients were included (68 AR, 45 IBR). AR utilised deep inferior epigastric perforator flaps; IBR cohort consisted of 41 direct-to-implant procedures and four latissimus dorsi flaps combined with implants. Among available baseline variables, cohorts were broadly similar except that AR patients were slightly older. Reconstruction failure was analysed in all IBR patients; four IBR patients were not evaluable for subsequent capsular contracture and cosmetic assessment because of implant removal before late assessment. Reconstruction failure occurred exclusively in IBR (28.9% [13 of 45] vs. 0% [0/68] in AR; P < 0.001). Clinically significant firmness was observed in 46.3% (19/41) of IBR versus 14.7% (10/68) of AR patients (P < 0.001). Fat necrosis occurred in 16.2% of AR patients without flap loss. Good/Excellent physician-assessed cosmesis was more frequent after AR (83.8% vs. 36.6%; P < 0.001). Recurrence rates were comparable between cohorts. CONCLUSIONS: AR was associated with higher reconstruction survival and more favourable physician-assessed cosmetic outcomes compared with predominantly direct-to-implant, subpectoral IBR after PMRT. For patients with a high probability of requiring PMRT, AR should be discussed early and strongly considered when clinically feasible.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.