Prepectoral Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy: An Assessment of Clinical Outcomes and Benefits.

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Hani Sbitany, Clara Gomez-Sanchez, Merisa Piper, Rachel Lentz

Author Information

Hani Sbitany: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco.
Clara Gomez-Sanchez: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco.
Merisa Piper: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco.
Rachel Lentz: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco.

PMID: 30589770 DOI: 10.1097/PRS.0000000000005140

BACKGROUND: Prepectoral breast reconstruction following mastectomy has become a more widely performed technique in recent years because of its numerous benefits for women. These include full pectoralis muscle preservation, reduced loss of strength, reduced pain, and elimination of animation deformity. As with any breast reconstruction technique, widespread adoption is dependent on a low morbidity profile in the setting of postmastectomy radiation therapy, as this adjuvant therapy is routine in breast cancer treatment. The authors assess the clinical outcomes of patients undergoing postmastectomy radiation therapy following prepectoral breast reconstruction, and compare these to outcomes of patients undergoing postmastectomy radiation therapy with submuscular reconstruction.
METHODS: A single surgeon's experience with immediate prepectoral breast reconstruction, followed by postmastectomy radiation therapy, from 2015 to 2017 was reviewed. Patient demographics and incidence of complications during the tissue expander stage were assessed. In addition, the morbidity profile of these patients was compared to that of patients undergoing submuscular/dual-plane reconstruction and postmastectomy radiation therapy over the same period.
RESULTS: Over 3 years, 175 breasts underwent immediate prepectoral reconstruction, and 236 breasts underwent immediate submuscular/dual-plane reconstruction. Overall rates of adjuvant radiation therapy (postmastectomy radiation therapy) were similar between prepectoral [26 breasts (14.9 percent)] and submuscular [31 breasts (13.1 percent)] (p = 0.6180) reconstruction. There were no significant differences in complication rates between the two reconstructive cohorts, in the setting of postmastectomy radiation therapy, including rates of explantation (15.4 percent versus 19.3 percent; p = 0.695).
CONCLUSIONS: Prepectoral breast reconstruction is a safe and effective option in the setting of postmastectomy radiation therapy. The morbidity profile is similar to that encountered with submuscular reconstruction in this setting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Adult

Breast Neoplasms

Cohort Studies

Databases, Factual

Esthetics

Female

Follow-Up Studies

Graft Rejection

Graft Survival

Humans

Mammaplasty

Mastectomy, Subcutaneous

Middle Aged

Pectoralis Muscles

Radiotherapy, Adjuvant

Retrospective Studies

Surgical Flaps

Treatment Outcome

Wound Healing

Journal Article

Outcomes Utilizing Inspira Implants in Primary Aesthetic and Reconstructive Surgery.Advances in Tissue Expander Technology Enable Early Targeted Intervention in Prepectoral Breast Reconstruction.Prepectoral implant reconstruction in the setting of post-mastectomy radiation.A systematic review and meta-analysis of postmastectomy radiation therapy on prepectoral versus subpectoral breast reconstruction.Prepectoral implant-based breast reconstruction: a joint consensus guide from UK, European and USA breast and plastic reconstructive surgeons.Fat Grafting and Prepectoral Prosthetic Reconstruction with Polyurethane-Covered Implants: Protective Role against Adjuvant Radiotherapy.Immediate Breast Reconstruction in Skin-Reducing Mastectomy with Prepectoral Polyuretane (Pu) Implant Covered with an Autologous Dermo-Adipose Flap.Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion.The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study.Impact of Prepectoral vs. Subpectoral Tissue Expander Placement on Post-mastectomy Radiation Therapy Delivery: A Retrospective Cohort Study.

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