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Open Access 03-02-2025 | Mastectomy | Research

Patient-reported outcomes after immediate and delayed DIEP-flap breast reconstruction in the setting of post-mastectomy radiation therapy—results of the multicenter UMBRELLA breast cancer cohort

Authors: Britt A. M. Jansen, Claudia A. Bargon, Maria A. Bouman, Dieuwke R. Mink van der Molen, Emily. L. Postma, Femke van der Leij, Erik Zonnevylle, Quinten Ruhe, Sven E. Bruekers, Wiesje Maarse, Sabine Siesling, Danny A. Young-Afat, Annemiek Doeksen, Helena M. Verkooijen, UMBRELLA study group

Published in: Breast Cancer Research and Treatment

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Abstract

Purpose

Timing of Deep Inferior Epigastric artery Perforator (DIEP)-flap breast reconstruction in the context of post-mastectomy radiotherapy for breast cancer patients is topic of debate. We compared the impact of immediate (before radiotherapy) versus delayed (after radiotherapy) DIEP-flap breast reconstruction (IBR versus DBR) on short- and long-term patient-reported outcomes (PROs).

Methods

Within the prospective, multicenter breast cancer cohort (UMBRELLA), we identified 88 women who underwent immediate or delayed DIEP-flap breast reconstruction and received PMRT. At 6 and 12 months post-mastectomy, as well as on long-term (≥ 12 months post-reconstruction) body image, breast symptoms, physical functioning, and pain were measured by EORTC-QLQ-30/BR23. Additionally, long-term evaluation included satisfaction with breast(s), physical well-being and self-reported adverse effects of radiation as measured by BREAST-Q, and late treatment toxicity. PROs were compared between groups using independent sample T-test.

Results

IBR was performed in 56 patients (64%) and DBR in 32 patients (36%), with 15 months of median time to reconstruction. At 6 and 12 months post-mastectomy, better body image and physical functioning were observed after IBR. No statistically nor clinically relevant differences were observed in long-term EORTC and BREAST-Q outcomes (median follow-up 37–41 months for IBR vs. 42–46 months for DBR). Patients with IBR reported more fibrosis and movement restriction (median follow-up 29 vs. 61 months, resp.).

Conclusion

Long-term PROs were comparable for patients with IBR and DBR, despite more patient-reported fibrosis and movement restriction after IBR. Therefore, both treatment pathways can be considered when opting for autologous breast reconstruction in the setting of PMRT.
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Metadata
Title
Patient-reported outcomes after immediate and delayed DIEP-flap breast reconstruction in the setting of post-mastectomy radiation therapy—results of the multicenter UMBRELLA breast cancer cohort
Authors
Britt A. M. Jansen
Claudia A. Bargon
Maria A. Bouman
Dieuwke R. Mink van der Molen
Emily. L. Postma
Femke van der Leij
Erik Zonnevylle
Quinten Ruhe
Sven E. Bruekers
Wiesje Maarse
Sabine Siesling
Danny A. Young-Afat
Annemiek Doeksen
Helena M. Verkooijen
UMBRELLA study group
Publication date
03-02-2025
Publisher
Springer US
Published in
Breast Cancer Research and Treatment
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-025-07613-w

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