Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy

Sarah M. Elswick, Christin A. Harless, Sarah N. Bishop, Cathy D. Schleck, Jayawant Mandrekar, Ryan D. Reusche, Robert Mutter, Judy C Boughey, Steven R. Jacobson, Valerie Lemaine

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND: Two-stage subpectoral implant-based breast reconstruction is the most common method for breast reconstruction. Recent advances in surgical techniques and technology have made prepectoral implant-based breast reconstruction feasible. There are limited data on outcomes after prepectoral implant-based breast reconstruction and postmastectomy radiation therapy. METHODS: A retrospective review of consecutive patients undergoing immediate two-stage prepectoral implant-based breast reconstruction with postmastectomy radiation therapy was performed. Outcomes of irradiated breasts were compared with nonirradiated breasts in bilateral cases. RESULTS: Ninety-three cases of prepectoral implant-based breast reconstruction in 54 women who underwent immediate two-stage reconstruction (39 bilateral and 15 unilateral) and unilateral postmastectomy radiation therapy were identified. Mean follow-up was 19 months from mastectomy and tissue expander reconstruction and 9 months from implant placement. Crude complication rates in irradiated versus nonirradiated sides were as follows: surgical-site infection, 18.5 percent versus 7.7 percent; seroma, 5.6 percent versus 5.1 percent; mastectomy skin flap necrosis, 1.9 percent versus 2.6 percent; wound dehiscence, 1.9 percent versus 7.7 percent; capsular contracture, 1.9 percent versus 0 percent; hematoma, 1.9 percent versus 2.6 percent; and extrusion, 1.9 percent versus 0 percent. On univariate analysis, there were no risk factors associated with any complication, including radiation therapy, surgical-site infection, unplanned readmissions, and unplanned return to the operating room. To date, reconstruction has been completed in 96 percent of patients, with successful implant-based breast reconstruction in 81 breasts (45 irradiated breasts and 36 nonirradiated breasts). CONCLUSIONS: Early data of prepectoral implant-based breast reconstruction in patients with postmastectomy radiation therapy show promising results. Postmastectomy radiation therapy should not be an absolute contraindication to prepectoral implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalPlastic and Reconstructive Surgery
Volume142
Issue number1
DOIs
StatePublished - Jul 1 2018

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Mammaplasty
Radiotherapy
Breast
Surgical Wound Infection
Mastectomy
Tissue Expansion Devices
Seroma
Contracture
Operating Rooms
Hematoma
Necrosis
Technology
Skin
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Elswick, S. M., Harless, C. A., Bishop, S. N., Schleck, C. D., Mandrekar, J., Reusche, R. D., ... Lemaine, V. (2018). Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy. Plastic and Reconstructive Surgery, 142(1), 1-12. https://doi.org/10.1097/PRS.0000000000004453

Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy. / Elswick, Sarah M.; Harless, Christin A.; Bishop, Sarah N.; Schleck, Cathy D.; Mandrekar, Jayawant; Reusche, Ryan D.; Mutter, Robert; Boughey, Judy C; Jacobson, Steven R.; Lemaine, Valerie.

In: Plastic and Reconstructive Surgery, Vol. 142, No. 1, 01.07.2018, p. 1-12.

Research output: Contribution to journalArticle

Elswick, Sarah M. ; Harless, Christin A. ; Bishop, Sarah N. ; Schleck, Cathy D. ; Mandrekar, Jayawant ; Reusche, Ryan D. ; Mutter, Robert ; Boughey, Judy C ; Jacobson, Steven R. ; Lemaine, Valerie. / Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy. In: Plastic and Reconstructive Surgery. 2018 ; Vol. 142, No. 1. pp. 1-12.
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AU - Mandrekar, Jayawant

AU - Reusche, Ryan D.

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