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Background: Post-mastectomy radiotherapy (PMRT) applied on implant-assisted immediate breast reconstruction (IBR) involves a marked increase in complication rate. The recent opportunity of performing an ADM-assisted prepectoral breast reconstruction (PPBR) raised the hypotesis of a protective interaction between ADM and periprosthetic tissues under PMRT.Methods: We performed a retrospective monocentric analysis of a cohort of consecutively treated patients undergone one-step PPBR between January 2015 and September 2018. The aim is to examine complication rate and aesthetic satisfaction of patients, in order to evaluate if this reconstructive technique could be recommendable in PMRT setting. Group 1 comprised 158 patients not submitted to PMRT and Group 2 twenty-eight patients undergone PMRT.Results: All post-operative complications were not statistically different between the two groups, except for capsular contracture (P=0.011). We obtained very high percentages in all BREAST-Q categories in Group 2 patients: satisfaction with breasts 86.8±13.9, satisfaction with implants 6.5±3.0, high satisfaction for no adverse effects of radiation 15.7±6.8. According to multivariate analysis no risk factor was significantly associated with complications. Conclusions:We may conclude that one-step PPBR with porcine ADM followed by PMRT is well tolerated, with no significant risk of adverse outcomes, at least in the short-term follow-up. These promising outcomes warrant further studies to examine the existence of a protective effect due to ADM integration with subcutaneous tissue.

Background: Breast reconstruction after salvage mastectomy (SM) for recurrent cancer represents a challenge in preradiated patients due to the increased complication rate. Latissimus dorsi myocutaneous flap (LDMF) represents a good reconstructive option due to its versatility, safety, and adaptability. Methods: Fifty-nine patients treated in the Breast Surgery Unit at the University Hospital of Parma (Italy) between January 2010 and December 2017 for ipsilateral breast recurrent cancer, previously treated by partial mastectomy plus whole-breast radiation therapy, were analyzed. They underwent SM and immediate reconstruction with implant-assisted pedicled LDMF. We registered local treatment, oncologic characteristics, complications, capsular contracture rate, DASH test, and BREAST-Q scores. Results: Mean implant volume was 403 g (range 135–650 g). Contralateral operations were 16/59 (27.1%). We obtained complete postoperative pain control in most cases with paracetamol. Medium hospital stay was 2.8 days. We registered 3.4% major complications and 6.8% minor ones. Mean follow-up was 26.65 months (range 3–91.9 months). DASH questionnaire evidenced no disability for 71.19% of patients and minimum disability for 28.81% of them. BREAST-Q Aesthetic Questionnaire obtained 92.72%. No patient developed Baker III or IV capsular contracture. Conclusions: LDMF with implant is a reliable and safe procedure for 1-step breast reconstruction after SM for recurrent cancer in radiated breast. It entails a low rate of major complications, achieving stable and pleasant results without significant upper limb functional impairment, also for elderly women and larger breasts. Thus, a definite role is yet predictable for this flap in the setting of SM in all cases not suitable for free-flap reconstruction.

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