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Page 4 of 15 Ewing et al. Plast Aesthet Res 2024;11:22 https://dx.doi.org/10.20517/2347-9264.2024.11

Figure 1. General overview of the literature on radiation and its effects on cancer treatment and wound healing.

DISCUSSION
Traditional use of autologous tissue in a previously irradiated breast
Breast reconstruction aims to rebuild the breast mound using several types of flaps. Local pedicled flaps are
adjacent to the defect and remain attached to the original blood supply. Free flaps are donated vascularized
[29]
tissues (abdomen, back, buttocks, or thigh) transferred to the breast blood supply . Discussing the different
types of free flaps is beyond the scope of this article. However, these include transverse rectus abdominis
muscle (TRAM), muscle-sparing free TRAM, deep inferior epigastric perforator (DIEP), superficial inferior
epigastric artery (SIEA), profunda artery perforator (PAP), transverse upper gracilis (TUG), diagonal upper
gracilis (DUG), vertical upper gracilis (VUG), latissimus dorsi flap, gluteal artery perforator (GAP) flaps,
and others.

Autologous tissue is traditionally preferred for patients with previously irradiated breasts, as it enables the
transfer of healthy tissue to the irradiated tissue [23,24] . Radiation-induced complications in implant-based
reconstruction consist of capsular contracture, infection, and mastectomy flap necrosis. Radiation-induced
complications in autologous reconstruction involve volume loss, contracture, wound dehiscence, fat
necrosis, and flap fibrosis [30-31] . Compared to autologous tissue reconstruction, implant-based reconstruction
has a greater risk of surgical-site infection and reconstructive failure [32-34] . The optimal timing of autologous
tissue transfer relative to radiation continues to be a subject of debate and will be discussed later in this
article.

Autologous breast reconstruction in the irradiated field is associated with greater patient satisfaction and
improved quality of life compared to implant-based reconstruction. Reported complications of autologous
breast reconstruction following failed implant-based reconstruction include partial flap loss (3%),
hematoma (3%), vascular compromise (1%), and total flap loss (1%) [35,36] . Despite these complications,
autologous breast reconstruction as a salvage technique for failed implant-based breast reconstruction has
been found to have an acceptable complication risk profile and is associated with significantly improved
patient satisfaction and quality of life.