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

Abstract

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.

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

“…in PPBR vs 3.2%). Despite the high incidence of complications, no statistical evidence of influence between postmastectomy RT and PPBR outcomes were observed 26 …”

Prepectoral breast reconstruction

“…According to Sinnott et al, patients undergoing submuscular breast reconstruction who received PMRT had a capsular contracture rate three times greater, with more severe contractures (Baker grade III or IV) than did patients receiving PMRT who underwent prepectoral breast reconstruction [17]. Sbitany et al studied 26 breasts that underwent immediate prepectoral reconstruction and 31 breasts that underwent immediate submuscular/ dual plane reconstruction in the setting of PMRT and found no significant differences in complication rates between the two reconstructive groups [18].…”

Current Trends in Prepectoral Breast Reconstruction: A Survey of American Society of Plastic Surgeons Members

“…Radiation is known to cause fibrosis and contraction of the pectoralis major muscle and is a known risk factor for implant malposition and reconstructive failure in implant-based reconstruction. 23 Prepectoral implant placement has been shown to have similar overall morbidity to submuscular reconstruction in the setting of postmastectomy radiation, 24 , 25 but with possibly decreased capsular contracture and less pain. 26 Prepectoral reconstruction bypasses the scarred radiated muscle, which is much more likely to contract than the overlying skin.…”