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Multicenter Study
. 2025 Apr;210(3):759-769.
doi: 10.1007/s10549-025-07613-w. Epub 2025 Feb 3.

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

Britt A M Jansen  1   2 , Claudia A Bargon  3   4 , Maria A Bouman  5 , Dieuwke R Mink van der Molen  3 , Emily L Postma  4 , Femke van der Leij  6 , Erik Zonnevylle  5 , Quinten Ruhe  7 , Sven E Bruekers  8 , Wiesje Maarse  9 , Sabine Siesling  10   11 , Danny A Young-Afat  9 , Annemiek Doeksen #  4 , Helena M Verkooijen #  3   12 ; UMBRELLA study group
Affiliations
Multicenter Study

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

Britt A M Jansen et al. Breast Cancer Res Treat. 2025 Apr.

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.

Keywords: Breast cancer; DIEP-flap breast reconstruction; Late radiation toxicity; Oncoplastic breast surgery; Patient-reported outcome.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Research Ethics Committee (MREC) Utrecht (NL52651.041.15, MEC15/165). Consent to participate: Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection. a The Netherlands Cancer Registry does not document secondary breast reconstructions. In cases where patients were referred for their reconstruction to a hospital not affiliated with UMBRELLA, data regarding reconstruction is missing
Fig. 2
Fig. 2
Long-term patient-reported late toxicity after a minimum of 12 months post-reconstruction. IBR Immediate Breast Reconstruction, DBR Delayed Breast Reconstruction
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