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Long-term Outcomes Of Prepectoral Vs. Subpectoral Implant-based Breast Reconstruction Following Post-mastectomy Radiotherapy: A Prospective Comparison
Eva Roy, MD1, Shailesh Agarwal, MD
1, Rinaa Punglia, MD
2, Julia Wong, MD
2, Angela Tramontano, MPH
2, Yoon Chun, MD
1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Dana - Farber Cancer Institute, Boston, MA, USA.
PURPOSE: Prepectoral implant-based breast reconstruction (PP-IBR) is increasingly favored over subpectoral reconstruction (SP-IBR) to reduce animation deformity, yet data regarding its outcomes after post-mastectomy radiotherapy (PMRT) are limited. PMRT poses unique challenges, including progressive fibrosis and reconstruction compromise. This study aims to prospectively compare long-term outcomes of PP-IBR and SP-IBR following PMRT.
METHODS: Data were obtained from the multicenter randomized trial, Study of Radiation Fractionation on Patient Outcomes After Breast Reconstruction (FABREC). Complications, aesthetic results, and patient-reported outcomes (PROs) were assessed between groups. Complications included infection, explantation, delayed healing, and unplanned reoperation. The FACT-B and Breast-Q Reconstruction Module were administered, and aesthetic outcomes were evaluated by blinded reviewers at 6 and 18 months following PMRT. Multivariable analysis was performed to evaluate whether PP-IBR vs. SP-IBR was associated with outcomes after controlling for other covariates.
RESULTS: Among 380 patients, 224 underwent PP-IBR and 156 SP-IBR. Demographics were similar, except SP-IBR had a higher proportion of tissue expanders and lower body mass index (BMI). No significant differences were noted in complications or PROs, but higher BMI correlated with lower sexual well-being scores at both 6 and 18 months (Estimate -0.60, p=0.03). SP-IBR was associated with lower aesthetic score at 6 months compared to PP-IBR; however, only age remained significant at 18 months (Estimate -0.02, p=0.00).
CONCLUSION: In PMRT settings, both PP-IBR and SP-IBR exhibit comparable complication rates and long-term aesthetic and PRO outcomes. Patient factors, such as age and BMI, appear to play a more prominent role in overall outcomes.
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