Safety and Early Outcomes of Immediate Autologous Breast Reconstruction in Advanced Breast Cancer: An Indian Experience.

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.