by Sbitany, Hani;
Gomez-Sanchez, Clara; Piper, Merisa; Lentz, Rachel
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.
