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Peer-reviewedCC BY 4.0Cancers

Implant-Based Versus Autologous Reconstruction After Salvage Mastectomy for Ipsilateral Breast Tumor Recurrence in the Previously Irradiated Breast: A Consecutive Institutional Series and a Proposed Autologous-First Algorithm

  • Jongmoo Park1
  • Woosung Jang2
  • Myeong Jae Kang2
  • Sung Joon Kim3
  • Byoung-Soo Ko3
  • In Hee Lee4
  • Joon Suk Moon5
  • Byeongju Kang5
  • Jeeyeon Lee5
  • Ho Yong Park5
  • Jeong Yeop Ryu2
  • Kang Young Choi2
3 more authors
  • Jung Dug Yang2
  • Ho Yun Chung2
  • Joon Seok Lee2
5 affiliations
  1. 1Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
  2. 2Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
  3. 3Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
  4. 4Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
  5. 5Department of Surgery, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
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Abstract

Background: In postmastectomy radiotherapy, radiation reaches an already-reconstructed breast, and implant-based reconstruction remains feasible in selected patients. Far less studied is reconstruction within a previously irradiated field: after breast-conserving therapy, ipsilateral breast tumor recurrence (IBTR), and salvage mastectomy. We compared implant-based and autologous reconstruction in this setting and propose a hypothesis-generating treatment algorithm. Methods: From 2219 consecutive breast reconstructions (2012–2026), we cross-matched implant-removal, radiotherapy, and local-recurrence registries to identify all immediate total reconstructions of a previously irradiated breast after salvage mastectomy for IBTR (n = 13; 8 implant-based [all stand-alone, without vascularized flap coverage], 5 autologous [all latissimus dorsi-based]). The primary endpoint was reconstruction failure, defined in a modality-neutral manner as definitive loss or abandonment of the reconstruction; implant-based reconstructions of breasts not previously irradiated at the time of reconstruction (n = 689) served as a descriptive institutional reference cohort. Results: Seven of eight implants (87.5%) were removed at 3 to 51 months; the single retained implant has a persistent wound; none achieved complication-free success. Failure modes comprised early envelope necrosis, periprosthetic infection, and late attritional failure; chronic retained-capsule seroma followed removal without capsulectomy. All five autologous reconstructions healed without failure or unplanned reoperation (reconstruction failure, 7/8 [87.5%; 95% CI, 47.3–99.7%] vs. 0/5 [0%; 95% CI, 0–52.2%], p = 0.005; log-rank p = 0.039; median follow-up, 32.0 vs. 10.9 months; failure or major complication, 8/8 vs. 0/5, p = 0.0008). The implant-removal rate also exceeded that of the institutional reference cohort (87.5% vs. 11.2%; unadjusted, descriptive comparison). Conclusions: In this small consecutive series, stand-alone implant-based reconstruction of the previously irradiated breast was associated with a very high failure rate, whereas reconstruction importing well-vascularized autologous tissue healed in every case, a pattern biologically consistent with chronic radiation injury. These findings constitute a strong cautionary signal rather than definitive evidence. Our findings support an autologous-first approach after salvage mastectomy of the irradiated breast; stand-alone implant-based reconstruction should be offered only to carefully selected, fully counseled patients, and the proposed algorithm requires external validation.

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Cite

BibTeXRIS
BibTeX
@article{park2026implantbased,
  title = {{Implant-Based Versus Autologous Reconstruction After Salvage Mastectomy for Ipsilateral Breast Tumor Recurrence in the Previously Irradiated Breast: A Consecutive Institutional Series and a Proposed Autologous-First Algorithm}},
  author = {Jongmoo Park and Woosung Jang and Myeong Jae Kang and Sung Joon Kim and Byoung-Soo Ko and In Hee Lee and Joon Suk Moon and Byeongju Kang and Jeeyeon Lee and Ho Yong Park and Jeong Yeop Ryu and Kang Young Choi and Jung Dug Yang and Ho Yun Chung and Joon Seok Lee},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18203409},
  url = {https://www.mdpi.com/2072-6694/18/20/3409},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Implant-Based Versus Autologous Reconstruction After Salvage Mastectomy for Ipsilateral Breast Tumor Recurrence in the Previously Irradiated Breast: A Consecutive Institutional Series and a Proposed Autologous-First Algorithm
AU  - Jongmoo Park
AU  - Woosung Jang
AU  - Myeong Jae Kang
AU  - Sung Joon Kim
AU  - Byoung-Soo Ko
AU  - In Hee Lee
AU  - Joon Suk Moon
AU  - Byeongju Kang
AU  - Jeeyeon Lee
AU  - Ho Yong Park
AU  - Jeong Yeop Ryu
AU  - Kang Young Choi
AU  - Jung Dug Yang
AU  - Ho Yun Chung
AU  - Joon Seok Lee
PY  - 2026
DA  - 2026/10/01
JO  - Cancers
DO  - 10.3390/cancers18203409
UR  - https://www.mdpi.com/2072-6694/18/20/3409
AB  - Background: In postmastectomy radiotherapy, radiation reaches an already-reconstructed breast, and implant-based reconstruction remains feasible in selected patients. Far less studied is reconstruction within a previously irradiated field: after breast-conserving therapy, ipsilateral breast tumor recurrence (IBTR), and salvage mastectomy. We compared implant-based and autologous reconstruction in this setting and propose a hypothesis-generating treatment algorithm. Methods: From 2219 consecutive breast reconstructions (2012–2026), we cross-matched implant-removal, radiotherapy, and local-recurrence registries to identify all immediate total reconstructions of a previously irradiated breast after salvage mastectomy for IBTR (n = 13; 8 implant-based [all stand-alone, without vascularized flap coverage], 5 autologous [all latissimus dorsi-based]). The primary endpoint was reconstruction failure, defined in a modality-neutral manner as definitive loss or abandonment of the reconstruction; implant-based reconstructions of breasts not previously irradiated at the time of reconstruction (n = 689) served as a descriptive institutional reference cohort. Results: Seven of eight implants (87.5%) were removed at 3 to 51 months; the single retained implant has a persistent wound; none achieved complication-free success. Failure modes comprised early envelope necrosis, periprosthetic infection, and late attritional failure; chronic retained-capsule seroma followed removal without capsulectomy. All five autologous reconstructions healed without failure or unplanned reoperation (reconstruction failure, 7/8 [87.5%; 95% CI, 47.3–99.7%] vs. 0/5 [0%; 95% CI, 0–52.2%], p = 0.005; log-rank p = 0.039; median follow-up, 32.0 vs. 10.9 months; failure or major complication, 8/8 vs. 0/5, p = 0.0008). The implant-removal rate also exceeded that of the institutional reference cohort (87.5% vs. 11.2%; unadjusted, descriptive comparison). Conclusions: In this small consecutive series, stand-alone implant-based reconstruction of the previously irradiated breast was associated with a very high failure rate, whereas reconstruction importing well-vascularized autologous tissue healed in every case, a pattern biologically consistent with chronic radiation injury. These findings constitute a strong cautionary signal rather than definitive evidence. Our findings support an autologous-first approach after salvage mastectomy of the irradiated breast; stand-alone implant-based reconstruction should be offered only to carefully selected, fully counseled patients, and the proposed algorithm requires external validation.
SN  - 2072-6694
ER  -