American Association of Plastic Surgeons

AAPS Home AAPS Home Past & Future Meetings Past & Future Meetings
Facebook   Instagram   Twitter   YouTube   LinkedIn

Back to 2025 Abstracts


Characterizing The Histological And Clinical Effects Of Radiation And Tissue Expander Plane On The Recipient Internal Mammary Vessels In Staged Autologous Breast Reconstruction
Jeffrey Khong, BS1, Katherine J. Zhu, BS1, Terrence Tsou, BA1, Priscila Cevallos, MD2, Maheen F. Akhter, BS2, Justine Colvin, BS2, Pooja Yesantherao, MD2, Erica Lee, MS1, Jiangxia Wang, MA, MS3, Gordon Lee, MD2, Dung Nguyen, MD2, Carisa M. Cooney, MPH1, Damon S. Cooney, MD, PhD1, Salih Colakogluu, MD1, Gedge Rosson, MD1, Lily R. Mundy, MD1, Rahim Nazerali, MD2, Kristen P. Broderick, MD1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Stanford University School of Medicine, Stanford, CA, USA, 3Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

PURPOSE: Post-mastectomy radiation therapy (PMRT) and tissue expander (TE) plane may impact internal mammary (IM) vessel quality in autologous breast reconstruction when placing an expander before delayed reconstruction. The biomechanical benefit of prepectoral over subpectoral TE placement is unclear. We aimed to clinically and histomorphometrically assess TE plane and PMRT impact on IM vessels.
METHODS: We conducted a multicenter prospective cohort study of 59 patients (107 breasts) undergoing autologous reconstruction between 2020-2024. Intraoperatively, 3-4 mm full-thickness IM artery and vein segments were obtained. Surgeons rated dissection difficulty and vessel integrity on 5-point Likert scales. Vessel thickness was measured with Masson’s trichome stains, elastin/collagen with VVG, and smooth muscle actin (SMA) and CD68 macrophages with murine antibody.
RESULTS: Demographics, intraoperative history, and postoperative complications were similar between cohorts (p>0.05). PMRT was associated with thicker intima (p=0.049), media (p=0.03), and veins (p=0.003) in ipsi- and contralateral vessels compared to non-radiated. Immediate autologous (no TE) and prepectoral TE vessel morphology were more similar, while vessels from subpectoral TE breasts displayed more macrophages (p=0.001), thicker intima (p=0.001), media (p<0.05), and veins (p<0.05), higher elastin/collagen ratios (p<0.001), and lower SMA percentages (p=0.02). Although not significant, surgeons rated subpectoral TE vessels as worse quality (p=0.4).
CONCLUSION: Subpectoral TE placement and radiation demonstrate greater IM vessel fibrosis and remodeling. Prepectoral TE placement may preserve recipient vessel morphology and reduce poor postoperative outcomes.


Back to 2025 Abstracts