Breast reduction and mastopexy procedures on previously irradiated breasts: A retrospective study.

[BACKGROUND] Post-radiation fibrosis and vascular compromise significantly complicate elective breast surgeries in previously irradiated patients, despite a high incidence of post-treatment asymmetry and macromastia. This study evaluates complication profiles across surgical techniques to provide evidence-based guidance for breast reduction and mastopexy in irradiated breasts.

[METHODS] A retrospective cohort of 41 patients with prior breast irradiation undergoing bilateral breast reduction (n=30), mastopexy (n=7), or mixed procedures (n=4) between 2015-2023 was analyzed. Reduction techniques included superior pedicle (n=4), supero-medial pedicle (n=12), and Thorek free nipple graft (n=14); mastopexies employed Wise-pattern superior pedicle techniques. Outcomes were compared with 1442 non-irradiated breast reductions. Complications were classified as major (reoperation required) or minor (conservatively managed). Statistical analysis utilized Fisher's exact tests and odds ratios (SPSS v26).

[RESULTS] Irradiated breasts had significantly higher overall complication rates compared to non-irradiated controls (44% vs. 21%; OR 3.017; p=0.0014), with seromas occurring exclusively in irradiated cases (15% vs. 0%; p<0.001). Mastopexies showed higher dehiscence rates than reductions (29% vs. 0%; p=0.01). Among reduction techniques, the supero-medial pedicle had the highest complication rate (67%), while Thorek procedures showed no seromas (p=0.04). No major complications occurred; revisions (15%) addressed asymmetry only.

[CONCLUSIONS] Breast surgery in irradiated fields remains viable when guided by technique-specific risk profiles and conservative tissue handling. Mastopexy carries elevated dehiscence risks, while the Thorek technique may reduce seroma formation in high-risk patients. Because subgroup analyses were under-powered, all technique-related recommendations should be regarded as preliminary and hypothesis-generating, pending validation in larger multicentre cohorts.