Less reconstruction failure in autologous over implant-based breast reconstructions in patients with a history of breast conserving therapy

Introduction: An increasing number of women present for mastectomy and reconstruction following prior lumpectomy and irradiation, also known as breast-conserving therapy (BCT). While reconstruction after postmastectomy radiotherapy is well studied, outcomes following prior BCT remain less clearly defined. This study aimed to compare reconstructive outcomes in patients with a history of BCT. Methods: A retrospective review of patients with autologous or implant-based reconstructions with a history of BCT between January 2017 and March 2025 was performed. Patients were compared with radiation-naïve controls and reconstructive outcomes were compared. Propensity score matching was used to minimize selection bias. Complications were categorized as major, minor, or any complication. Results: In the matched autologous cohort, 50 BCT patients were matched to 200 radiation-naïve patients; those with prior BCT experienced higher rates of any complication (36.0% vs 20.0%, p=0.02), mainly caused by higher infection (8.0% vs 3.0%, p=0.2) and mastectomy skin flap necrosis (10.0% vs 3.5%, 0.07). In the matched implant-based cohort (49 BCT, 490 radiation-naïve), patients with prior BCT experienced significantly higher rates for major, minor and any complications (all p≤0.001). When comparing autologous BCT to implant-based BCT (45 matched in each), autologous reconstruction experienced lower rates of reconstruction failure (2.2% vs 24.4%, p<0.001). Other complications were comparable. Conclusion: A history of BCT is associated with increased postoperative complications following breast reconstruction, particularly in implant-based reconstructions. Autologous reconstruction offers lower failure rates in this population and should be strongly considered when feasible.