by Elswick, Sarah
M.; Harless, Christin A.; Bishop, Sarah N.; Schleck, Cathy D.; Mandrekar, Jay;
Reusche, Ryan D.; Mutter, Robert W.; Boughey, Judy C.; Jacobson, Steven R.;
Lemaine, Valerie
Background: Two-stage
subpectoral implant-based breast reconstruction is the most common method for
breast reconstruction. Recent advances in surgical techniques and technology
have made prepectoral implant-based breast reconstruction feasible. There are
limited data on outcomes after prepectoral implant-based breast reconstruction
and postmastectomy radiation therapy. Methods: A retrospective review of consecutive
patients undergoing immediate two-stage prepectoral implant-based breast
reconstruction with postmastectomy radiation therapy was performed. Outcomes of
irradiated breasts were compared with nonirradiated breasts in bilateral cases.
Results: Ninety-three cases of prepectoral implant-based breast reconstruction
in 54 women who underwent immediate two-stage reconstruction (39 bilateral and
15 unilateral) and unilateral postmastectomy radiation therapy were identified.
Mean follow-up was 19 months from mastectomy and tissue expander reconstruction
and 9 months from implant placement. Crude complication rates in irradiated
versus nonirradiated sides were as follows: surgical-site infection, 18.5
percent versus 7.7 percent; seroma, 5.6 percent versus 5.1 percent; mastectomy
skin flap necrosis, 1.9 percent versus 2.6 percent; wound dehiscence, 1.9
percent versus 7.7 percent; capsular contracture, 1.9 percent versus 0 percent;
hematoma, 1.9 percent versus 2.6 percent; and extrusion, 1.9 percent versus 0 percent.
On univariate analysis, there were no risk factors associated with any
complication, including radiation therapy, surgical-site infection, unplanned
readmissions, and unplanned return to the operating room. To date,
reconstruction has been completed in 96 percent of patients, with successful
implant-based breast reconstruction in 81 breasts (45 irradiated breasts and 36
nonirradiated breasts). Conclusions: Early data of prepectoral implant-based
breast reconstruction in patients with postmastectomy radiation therapy show
promising results. Postmastectomy radiation therapy should not be an absolute
contraindication to prepectoral implant-based breast reconstruction. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
