Meenu JOSE, Shivani SABLE, Tabassum WADASADAWALA, Rajiv SARIN, Rima PATHAK, Revathy KRISHNAMURTHY, Shalaka JOSHI, Vinaykant SHANKHDHAR, Dushyant JAISWAL, Saumya MATHEWS, Mayur MANTRI
European Journal of Breast Health - 2026;22(3):285-293
Objective: Post-mastectomy breast reconstruction improves body image and quality of life for women with breast cancer. Most adverse events emerge within the first 90 days and may contribute to long-term morbidity. This study prospectively evaluated the incidence and predictors of early complications following immediate autologous breast reconstruction in women with locally advanced breast cancer. Materials and Methods: Prospective data from a randomized controlled trial (CTRI/2017/01/007745) involving women undergoing immediate autologous whole breast reconstruction were analysed. Breast and donor-site complications were recorded and graded using Clavien-Dindo classification over 0-30 and 31-90 days. Univariate and multivariate analyses were performed to identify risk factors. Results: A total of 160 patients were included. The mean age was 37+/-7 years; body mass index (BMI) was 25.7+/-4.6; 25.6% had comorbidities. Deep inferior epigastric perforator (DIEP) flaps accounted for 85% of reconstructions. Within 0-30 days, 45% developed primary-site complications; 33% developed donor -site complications. At 31-90 days, primary-site complications were reduced to 15%, and donor -site complications to 13%. Re-exploration was required in 11%; however, no flap loss was observed. Univariate analysis showed age >37, BMI >=25, diabetes, multiple comorbidities, any comorbidity, and DIEP increased primary-site complication risk and BMI >=25 and DIEP predicted donor -site events. Multivariate analysis confirmed multiple comorbidities and DIEP as predictors of primary-site complications, while BMI >=25 and DIEP predicted donor -site complications. As DIEP flaps predominated, in our patients technique-based comparisons should be interpreted cautiously. Conclusion: Immediate autologous whole-breast reconstruction in patients with advanced breast cancer undergoing multimodal therapy, including intensive chemotherapy and radiotherapy, resulted in a high overall complication rate but no reconstructive failures, highlighting the need for a selective, individualized approach with comprehensive preoperative counselling and shared decision-making.
