Highlight
- Among irradiated patients, prior IBR nearly doubles the risk of perioperative arterial re-anastomosis.
- There was no significant difference in rates of flap necrosis between patients with or without prior IBR, regardless of radiotherapy exposure.
- Vein coupler sizes used during microsurgery were smaller in irradiated patients, indicating altered vessel conditions potentially due to fibrosis.
- DIEP flap reconstruction remains a safe option after implant failure and radiotherapy, though with increased surgical complexity.
