What does this research mean for the field?

Delayed breast reconstruction following postmastectomy radiation therapy (PMRT) is associated with lower postoperative complications and better cosmetic outcomes compared to immediate reconstruction, despite similar overall flap survival. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The analysis aims to evaluate the impact of postmastectomy radiation therapy on flap outcomes in breast reconstruction.

May 28, 2026Open Access

Postmastectomy Radiation Therapy on Flap Outcomes in Breast Reconstruction: A Systematic Review and Meta-analysis

Key Points

The analysis aims to evaluate the impact of postmastectomy radiation therapy on flap outcomes in breast reconstruction.
Systematic review and meta-analysis following PRISMA guidelines
Search conducted on PubMed and Cochrane Library (2000-2024)
Inclusion criteria focused on comparing flap outcomes between irradiated and nonirradiated groups.
Higher complication rates observed in irradiated flaps for immediate reconstruction, particularly fat necrosis and flap contracture.
Delayed reconstruction after PMRT showed fewer complications and better aesthetic outcomes.
Subgroup analysis indicated lower fat necrosis rates in deep inferior epigastric perforator flaps compared to other flaps.

Abstract

Background: Breast reconstruction is an important aspect of the process of recovery for patients recovering from mastectomy. However, postmastectomy radiation therapy (PMRT) disrupts flap perfusion and cosmetic results. These complications have prompted comparisons of irradiated and nonirradiated flaps, especially in immediate and delayed reconstruction. Methods: Using preferred reporting items for systematic reviews and meta-analyses guidelines, a PubMed and Cochrane Library search from the year 2000 to 2024 was performed to compare the irradiated and nonirradiated flaps. The inclusion criteria restricted the analysis to comparing flap viability, flap complications, aesthetic outcome, or satisfaction level of patients. The meta-analysis was used, and variance was reduced by using fixed- and random-effects models. Results: The analysis involved 12 studies showing that flaps receiving irradiation, particularly in immediate reconstructions, had higher complication rates, including fat necrosis and flap contracture. Nevertheless, delayed reconstruction following PMRT was linked to reduced postoperative complication rates and favorable reconstructive results, whereas flap survival did not differ between immediate and delayed reconstruction. Subgroup analysis demonstrated lower fat necrosis in deep inferior epigastric perforator flaps (≈12%) compared with transverse rectus abdominis muscle (≈25%) and latissimus dorsi flaps (≈40%), suggesting that flap-specific planning is necessary for irradiated patients. These pooled percentages reflect averaged values across included studies. Conclusions: Patients undergoing immediate reconstruction in the PMRT setting have increased rates of postoperative complications, especially fat necrosis, fibrosis, and flap contracture, and worse aesthetic outcomes. On the contrary, delayed reconstruction is associated with lower complications and better cosmetic results, whereas no significant difference is noted in flap survival between immediate and delayed reconstruction.

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