Autologous reconstruction outperformed implants after postmastectomy radiotherapy in cohort study

Women who underwent immediate autologous breast reconstruction followed by postmastectomy radiotherapy had substantially better reconstruction survival and physician-assessed cosmetic outcomes than women who received implant-based reconstruction, according to a multi-institutional retrospective cohort study published in Breast Cancer Research and Treatment. The study, covering patients treated between 2013 and 2024, compared late toxicities, cosmetic results and reconstruction failure across the two reconstructive approaches after radiotherapy.

The analysis included 113 patients, of whom 68 received autologous reconstruction using deep inferior epigastric perforator flaps and 45 received implant-based reconstruction. The implant cohort consisted of 41 direct-to-implant procedures and four latissimus dorsi flaps combined with implants. Among the baseline variables available for comparison, the two cohorts were broadly similar, although patients in the autologous group were slightly older.

Reconstruction failure occurred exclusively in the implant-based group, affecting 28.9 percent of those patients, or 13 of 45, compared with zero cases among the 68 autologous reconstruction patients, a difference the authors reported as statistically significant.

Clinically significant firmness was observed in 46.3 percent of implant patients, 19 of 41, versus 14.7 percent of autologous patients, 10 of 68. Four implant-based patients were not evaluable for contracture and cosmetic assessment because their implants had been removed before the late assessment, and reconstruction failure was analysed in all implant-based patients. Fat necrosis occurred in 16.2 percent of autologous reconstruction patients, and in none of these cases was it accompanied by flap loss.

Physician-assessed cosmetic outcomes on the Kroll scale favoured the autologous approach by a wide margin. Good or Excellent cosmesis ratings were recorded in 83.8 percent of autologous reconstruction patients compared with 36.6 percent of implant-based patients. Recurrence rates, by contrast, were comparable between the two cohorts, indicating that the reconstructive choice did not clearly affect oncological outcomes in this study population.

The authors concluded that autologous reconstruction was associated with higher reconstruction survival and more favourable physician-assessed cosmetic outcomes compared with predominantly direct-to-implant, subpectoral implant-based reconstruction after postmastectomy radiotherapy. They suggested that for patients with a high probability of requiring postmastectomy radiotherapy, autologous reconstruction should be discussed early and strongly considered when clinically feasible.

Subject of Research: Outcomes of autologous versus implant-based immediate breast reconstruction followed by postmastectomy radiotherapy

Article Title: Outcomes of postmastectomy radiotherapy in immediate autologous versus implant-based breast reconstruction: a multi-institutional cohort study

Article References: Lee, S. F., Admojo, L., Lin, Y.-H., Yip, P. L., Foroudi, F., Jassal, S., Law, M., Zantuck, N., Yong, C., Loh, S.-W., Chew, G., Bevington, E., Ng, S. L., Tsao, S. C.-H., Leech, T., Ooi, W. M., Neoh, D., Liew, J., & Chao, M. (2026). Outcomes of postmastectomy radiotherapy in immediate autologous versus implant-based breast reconstruction: a multi-institutional cohort study. Breast Cancer Research and Treatment, 220(1), Article 12. https://doi.org/10.1007/s10549-026-08098-x

Image Credits: AI Generated

DOI: 10.1007/s10549-026-08098-x

Keywords: breast reconstruction, postmastectomy radiotherapy, autologous reconstruction, implant-based reconstruction, capsular contracture, reconstruction failure, cosmetic outcomes, fat necrosis, DIEP flap, retrospective cohort study, Outcomes, postmastectomy