Journal of Modern OncologyJournal of Modern Oncology1815-14341815-1442LLC Obyedinennaya Redaktsiya10829310.26442/18151434.2023.1.202080Research ArticleInfluence of radiation therapy on the development of complications in single-stage autologous breast reconstruction with a DIEP-flap in breast cancer patients: a retrospective studyDuadzeIlona S.<p>Graduate Student, Sechenov First Moscow State Medical University (Sechenov University), Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre</p>ilona.duadze@mail.ruhttps://orcid.org/0000-0002-9577-584XKaprinAndrei D.<p>D. Sci. (Med.), Prof., Acad. RAS, National Medical Research Radiological Centre, People’s Friendship University of Russia (RUDN University)</p>ilona.duadze@mail.ruhttps://orcid.org/0000-0001-8784-8415ZikiryakhodzhaevAziz D.<p>D. Sci. (Med.), Sechenov First Moscow State Medical University (Sechenov University), Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre, People’s Friendship University of Russia (RUDN University)</p>azizz@mail.ruhttps://orcid.org/0000-0001-7141-2502ReshetovIgor V.<p>D. Sci. (Med.), Prof., Acad. RAS, Sechenov First Moscow State Medical University (Sechenov University)</p>ilona.duadze@mail.ruhttps://orcid.org/0000-0002-0909-6278UsovFedor N.<p>Cand. Sci. (Med.), Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre</p>fedus70@mail.ruhttps://orcid.org/0000-0001-9510-1434RasskazovaElena A.<p>Cand. Sci. (Med.), Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre</p>rasskaz2@yandex.ruhttps://orcid.org/0000-0003-0307-8252SukhotkoAnna S.<p>Cand. Sci. (Med.), Botkin Hospital</p>syxotya26@yandex.ruhttps://orcid.org/0000-0002-2337-5919StarkovaMarianna V.<p>Cand. Sci. (Med.), Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre</p>mariannastarkova@gmail.comhttps://orcid.org/0000-0003-4141-8414BagdasarovaDaria V.<p>Graduate Student, Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre</p>dasha.bagdasarova@gmail.comhttps://orcid.org/0000-0001-9195-4181DzhabrailovaDzhamilya S.<p>Oncologist, Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre</p>jamijabrailova17@gmail.ruhttps://orcid.org/0000-0002-7283-2530KhakimovaShakhnoza G.<p>Cand. Sci. (Med.), Tashkent Pediatric Medical Institute</p>shahnoz_hakimova@mail.ruhttps://orcid.org/0000-0001-6660-4649Sechenov First Moscow State Medical University (Sechenov University)Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological CentreNational Medical Research Radiological CentrePeople’s Friendship University of Russia (RUDN University)Botkin HospitalTashkent Pediatric Medical Institute17052023251687227052022Copyright © 2023, Consilium Medicum2023<p>Breast reconstruction after complex oncological treatment is an urgent issue due to the high incidence of breast cancer.</p>
<p><strong>Aim</strong>. To analyze the effect of postoperative radiotherapy on the incidence of fat necrosis in single-stage autologous breast reconstruction with a DIEP flap and to evaluate the number of complications in groups with and without postoperative radiotherapy, as well as to determine the risk factors for complications.</p>
<p><strong>Materials and methods</strong>. The medical records of 34 breast cancer patients who underwent one-stage breast reconstruction using a DIEP flap after skin-sparing/subcutaneous mastectomy with and without subsequent radiation therapy were retrospectively studied. The frequency of complications in groups with and without postoperative radiation therapy was assessed.</p>
<p><strong>Results</strong>. Complications developed in 22 (64.7%) patients out of 34. Mild complications developed in 6 (17.6%) patients (divergence of the edges of the postoperative wound of the anterior abdominal wall). Complications of moderate severity developed in 12 (35.3%) patients. Severe complications developed in 4 (11.8%) patients. Out of 22 patients, 6 (17.4%) patients developed areas of fat necrosis after remote radiation therapy in the delayed period, 4 (11.8%) patients, without ESWL, also developed fat necrosis of a part of the flap (areas up to 5 cm). Excision of the area of fat necrosis of the flap was performed in 2 (5.9%) cases under local anesthesia, the rest of the areas of fat necrosis were not excised. The percentage of complications was higher in the group of patients with obesity (20.6%), which indicates that obesity is a risk factor for the development of intraoperative and postoperative complications in patients with simultaneous breast reconstruction with a DIEP flap.</p>
<p><strong>Conclusion</strong>. During radiotherapy after breast reconstruction with a DIEP flap, the incidence of fat necrosis of the flap was higher. Obesity is a risk of intraoperative and postoperative complications in patients with simultaneous increased breast reconstruction with a DIEP flap, since the incidence of complications was in the group of patients with obesity.</p>autologous breast reconstructionperforator flapsreconstructive plastic surgeryDIEP flapbreast cancerautologous flapsfree flapsаутологичная реконструкция молочной железыперфорантные лоскутыреконструктивно-пластическая хирургияDIEP-лоскутрак молочной железыаутологичные лоскутысвободные лоскуты[Каприн А.Д., Старинский В.В., Шахзадова А.О. Злокачественные ново- образования в России в 2020 году (заболеваемость и смертность). М., 2021 [Kaprin AD, Starinskii VV, Shakhzadova AO. Zlokachestvennye novoobrazovaniia v Rossii v 2020 godu (zabolevaemost' i smertnost'). Moscow, 2021 (in Russian)].][Chan LK. Body image and the breast: the psychological wound. J Wound Care. 2010;19(4):133-138. DOI:10.12968/jowc.2010.19.4.133][Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Eng J Med. 2008;359(15):1590-601.][O'Connell RL, Di Micco R, Khabra K, et al. Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy. Plast Reconstr Surg. 2018;142(3):594-605. DOI:10.1097/PRS.0000000000004676][Saldanha IJ, Cao W, Broyles JM, et al. Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021. Report No.: 21-EHC027. DOI:10.23970/AHRQEPCCER245][Munder B, Andree C, Witzel C, et al. The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience. Geburtshilfe Frauenheilkd. 2020;80(6):628-38. DOI:10.1055/a-1116-2102][Craig ES, Lentz R, Srinivasa D, et al. Three-dimensional Analysis of How Radiation Affects Deep Inferior Epigastric Perforator (DIEP) Flap Volume, Projection, and Position in Breast Cancer Reconstruction. Ann Plast Surg. 2018;81(2):235-9. DOI:10.1097/SAP.0000000000001462][Yang TJ, Ho AY. Radiation therapy in the management of breast cancer. Surg Clin North Am. 2013;93(2):455-71.][Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg. 2009;124(2):395-408.][Clemens MW, Kronowitz SJ. Current perspectives on radiation therapy in autologous and prosthetic breast reconstruction. Gland Surg. 2015;4(3):222-31. DOI:10.3978/j.issn.2227-684X.2015.04.03][Crisera CA, Chang EI, Da Lio AL, et al. Immediate free flap reconstruction for advanced-stage breast cancer: is it safe? Plast Reconstr Surg. 2011;128(1):32-41.][Garvey PB, Clemens MW, Hoy AE, et al. Muscle-sparing TRAM flap does not protect breast reconstruction from postmastectomy radiation damage compared with the DIEP flap. Plast Reconstr Surg. 2014;133(2):223-33.]