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American Association of Plastic Surgeons

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Comparison of Radiation Protocols for Pre-pectoral vs. Sub-pectoral Implant-based Breast Reconstruction
Libby R. Copeland-Halperin, MD, Yulia Lyatskaya, Ph.D, Jennifer R. Bellon, MD, Matthew J. Carty, MD, Jessica Erdmann-Sager, MD.
The Brigham and Women's Hospital, Boston, MA, USA.

PURPOSE: In the United States, approximately one third of patients who undergo mastectomy will undergo post-mastectomy radiation therapy (PMRT). The presence of breast reconstruction may alter how PMRT is delivered. Pre-pectoral implant-based reconstruction has been widely adopted, but there is no data on the impact of pre-pectoral implant-based reconstruction on PMRT planning or delivery. Rather, prior studies have focused on complication rates and aesthetic outcomes. This study aims to examine whether there is a difference in radiation administration among patients undergoing pre-pectoral and sub-pectoral implant-based reconstruction.
METHODS: Radiation mapping protocols for 50 patients who received either immediate sub-pectoral or pre-pectoral implant-based reconstruction followed by PMRT at a large academic medical center will be retrospectively reviewed. The main outcomes of interest are whether patients who underwent pre-pectoral reconstruction have an increase in focal areas of decreased radiation delivery (i.e. "cold spots") in the pectoralis major muscle, and/or whether they have an increase in unwanted radiation reaching the heart and lungs.
RESULTS: The radiation protocols for 25 patients undergoing pre-pectoral and 25 undergoing sub-pectoral reconstruction followed by PMRT will be reviewed.
CONCLUSION: As pre-pectoral implant-based breast reconstruction becomes more common, it is essential to further study the effects of this technique on radiation dosing and oncologic outcomes. This is an initial exploratory study. Larger prospective studies are needed to better analyze long-term effects of pre-pectoral implant-based reconstruction on radiation dosing and recurrence rates.


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