Prepectoral Implant-Based Breast Reconstruction with Post-Mastectomy Radiation Therapy

Background: Two-stage subpectoral implant-based breast reconstruction (IBBR) is the most common method for breast reconstruction. Recent advances in surgical techniques and technology have made prepectoral IBBR feasible. There is limited data on outcomes after prepectoral IBBR and post-mastectomy radiation therapy (PMRT). Methods: A retrospective review of consecutive patients undergoing immediate two-stage prepectoral IBBR with PMRT was performed. Outcomes of radiated breasts were compared with non-radiated breasts in bilateral cases. Results: Ninety-three cases of prepectoral IBBR in 54 women who underwent immediate two-stage prepectoral IBBR (39 bilateral and 15 unilateral) and unilateral PMRT were identified. Mean follow-up was 19 months from mastectomy and tissue expander reconstruction and nine months from implant placement. Crude complication rates in radiated versus non-radiated sides were as follows: surgical site infection (SSI) 18.5% vs 7.7%, seroma 5.6% vs 5.1%, mastectomy skin flap necrosis 1.9% vs 2.6%, wound dehiscence 1.9% vs 7.7%, capsular contracture 1.9% vs 0%, hematoma 1.9% vs 2.6%, and extrusion 1.9% vs 0%. On univariate analysis there were no risk factors, including radiation, associated with any complication, SSI, unplanned readmissions, and unplanned return to the operating room. To date, reconstruction has been completed in 96% of patients, with successful IBBR in 81 breasts (45 radiated breasts and 36 non-radiated breasts). Conclusion: Early data of prepectoral IBBR in patients with PMRT show promising results. PMRT should not be an absolute contraindication to prepectoral IBBR. Financial Disclosure Statement: Dr. Jacobson is a Consultant to Allergan, Mentor, Sientra, LifeCell and Novadaq. Dr. Lemaine is a Consultant for LifeCell and Bonti. The remaining authors have no financial interest to declare in relation to the content of this article. REDCap database at our institution is funded through the Center for Clinical and Translational Science grant support (UL1 TR000135). IRB approval was obtained from Mayo Clinic Rochester. Authors' role: All authors made substantial contributions to the conception of the work, revised it critically for important intellectual content, approved of the submission of the final version to be reviewed for publication, and agree to be accountable for all aspects of the work. Corresponding author: Valerie Lemaine, MD, MPH, 200 First St SW, Rochester, MN 55905, Lemaine.Valerie@mayo.edu, Phone: 507-284-2736, Fax: 507-284-5994 ©2018American Society of Plastic Surgeons

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