ADM-Assisted Direct-to-Implant Prepectoral Breast Reconstruction in Postmastectomy Radiation Therapy Setting: Long-Term Results

Susanna Polotto; Giuseppe Pedrazzi; Marialuisa Bergamini; Nunziata D'Abbiero; Leonardo Cattelani

doi:10.1016/j.clbc.2023.06.011

ADM-Assisted Direct-to-Implant Prepectoral Breast Reconstruction in Postmastectomy Radiation Therapy Setting: Long-Term Results

Clin Breast Cancer. 2023 Oct;23(7):704-711. doi: 10.1016/j.clbc.2023.06.011. Epub 2023 Jul 1.

Authors

Susanna Polotto¹, Giuseppe Pedrazzi², Marialuisa Bergamini³, Nunziata D'Abbiero³, Leonardo Cattelani⁴

Affiliations

¹ Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham Breast Institute, Nottingham, UK; Breast Surgery Unit, University Hospital of Parma, Parma (PR), Italy. Electronic address: polotto.susanna@gmail.com.
² Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Parma (PR), Italy.
³ Radiotherapy Unit, University Hospital of Parma, Parma (PR), Italy.
⁴ Breast Surgery Unit, University Hospital of Parma, Parma (PR), Italy.

PMID: 37479666
DOI: 10.1016/j.clbc.2023.06.011

Abstract

Background: Postmastectomy radiotherapy (PMRT) on immediate breast reconstruction historically involved a marked increase in complication rate (up to 50%). Prepectoral breast reconstruction (PPBR) has shown promising early postoperative results. This study aims to evaluate PPBR long-term results in PMRT setting.

Materials and methods: This is a retrospective monocentric analysis of 485 PPBR (439 patients) undergoing Acellular-Dermal-Matrix assisted direct-to-implant reconstruction (46 bilateral procedures) between January 2015 and December 2020 (mean FU:35.6 months). Group 1 comprised 401 PPBR not submitted to PMRT, and 84 reconstructions receiving PMRT in Group 2. Patients' characteristics, postoperative complication and revisional surgery rate were examined. PMRT characteristics and subcutaneous tissue thickness, measured in Group 2 by CT scan, were also evaluated.

Results: Long-term complication rate was 11.2% in Group 1 vs. 21.4% in Group 2 (P-value = .019). Capsular contracture represented the only complication associated to a statistically significant difference between the 2 groups (P-value < .001). In Group 2, only 4.8% implant loss and 8.3% severe capsular contracture rate was found. In patients who underwent PMRT, 38.9% of complications settled with no consequences, and only 4.8% of patients needed revisional surgery in the long-term FU. According to multivariate analysis, drug intake and PMRT were significantly associated with postoperative complications. In Group 2, a thinner subcutaneous tissue was linked to a higher complication risk.

Conclusion: In our series, patients treated with PPBR who underwent PMRT, presented a low complication rate and minimal need for revisional surgery in the long-term follow-up, suggesting that this technique is feasible and safe also in PMRT context.

Keywords: ADM and breast reconstruction; Breast Radiotheraphy; Complications in radiotreated breast reconstruction; Implant-based breast reconstruction; Long-term results in readiotreated implant-based reconstructions.

MeSH terms

Breast Implantation* / adverse effects
Breast Implantation* / methods
Breast Implants* / adverse effects
Breast Neoplasms* / complications
Breast Neoplasms* / radiotherapy
Breast Neoplasms* / surgery
Contracture* / complications
Female
Humans
Mammaplasty* / adverse effects
Mammaplasty* / methods
Mastectomy / adverse effects
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Radiotherapy, Adjuvant / methods
Retrospective Studies
Tissue Expansion Devices / adverse effects