The Effects Of Radiation Status On Reconstructive Failure Rates In Prepectoral And Subpectoral Implant-based Breast Reconstruction
Yasmina Samaha, BS, Edward Ray, MD, Jiaxi Chen, MD, Randolph Sherman, MD.
Cedars-Sinai Medical Center, los angeles, CA, USA.
PURPOSE
Along with increasing breast cancer incidence (especially in younger women), annual mastectomy rates have gradually risen over the past decade. This trend is accompanied by a steady increase in implant-based breast reconstruction (IBR), as it remains the most common reconstructive approach following mastectomy. Breast implants may be placed over or under the pectoralis major muscle and multiple factors should be considered preoperatively to offer each patient the optimal approach. Identifying risk factors contributing to reconstructive failure will help in patient selection for each of these options.
METHODS
We report a single institution's IBR experience between 2007 and 2020, including cases performed by 51 plastic surgeons. For each stage of IBR, data on age, BMI, radiation status, and acute complications were tabulated.
RESULTS
1378 patients underwent subpectoral IBR (448 received radiation) and 264 underwent prepectoral IBR (79 received radiation.) Infection/wound dehiscence rates were highest in patients who underwent radiation and had prepectoral IBR (7.6%). Prepectoral IBR without radiation and subpectoral IBR with radiation resulted in similar complication rates (3.8% vs 3.6%, respectively). These complications trended higher for all patients who underwent radiation therapy. Higher rates of aesthetic reoperations occurred in subpectoral IBR with radiation (11.4%) in comparison to prepectoral IBR with radiation (1.3%) (p<0.05.)
CONCLUSIONS
Infection rates trended higher in patients who underwent prepectoral IBR regardless of radiation status while aesthetic reoperations occurred at a higher rate for subpectoral IBR with radiation. Radiation effects should be considered in the discussion of risk factors associated with different IBR techniques.
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