Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review

• Published in: Journal of clinical medicine Vol. 13; no. 1; p. 217
• Main Authors: Pfister, Pablo, Müller, Seraina L C, Eberhardt, Anna-Lena, Rodriguez, Medea, Menzi, Nadia, Haug, Martin, Schaefer, Dirk J, Kappos, Elisabeth A, Ismail, Tarek
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 29.12.2023; MDPI
• Subjects: adjuvant radiotherapy; Breast cancer; breast reconstruction; Cancer therapies; Decision making; Dosage and administration; Evaluation; flap volume; free flap; Mammaplasty; Mastectomy; Methods; Patient outcomes; Patient satisfaction; Quality of life; Radiation therapy; Radiotherapy; Review; Symmetry; Systematic review; Three dimensional imaging; Volumetric analysis; Switzerland; free flap; adjuvant radiotherapy; flap volume; breast reconstruction
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13010217

In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation.