ADM-Assisted Direct-to-Implant Prepectoral Breast Reconstruction in Postmastectomy Radiation Therapy Setting: Long-Term Results

Postmastectomy radiotherapy (PMRT) applied on breast reconstruction usually involves a marked increase in complication rate. This study analyses 485 prepectoral reconstructions (84 radiotreated), performed with Acellular-dermal-matrix assisted direct-to-implant technique. Low complication rate and minimal need for revisional surgery were reported in the long-term (mean FU 35.6 months). Therefore, this technique seems safe and feasible also in PMRT setting.Background: Postmastectomy radiotherapy (PMRT) on immediate breast reconstruction historically involved a marked increase in complication rate (up to 50%). Prepectoral breast reconstruction (PPBR) has shown promising early postop-erative results. This study aims to evaluate PPBR long-term results in PMRT setting. Materials and Methods: This is a retrospective monocentric analysis of 485 PPBR (439 patients) undergoing Acellular-Dermal-Matrix assisted direct-to-implant reconstruction (46 bilateral procedures) between January 2015 and December 2020 (mean FU:35.6 months). Group 1 comprised 401 PPBR not submitted to PMRT, and 84 reconstructions receiving PMRT in Group 2. Patients' characteristics, postoperative complication and revisional surgery rate were examined. PMRT characteristics and subcu-taneous tissue thickness, measured in Group 2 by CT scan, were also evaluated. Results: Long-term complication rate was 11.2% in Group 1 vs. 21.4% in Group 2 ( P-value = .019). Capsular contracture represented the only complication associated to a statistically significant difference between the 2 groups ( P-value < .001). In Group 2, only 4.8% implant loss and 8.3% severe capsular contracture rate was found. In patients who underwent PMRT, 38.9% of complications settled with no consequences, and only 4.8% of patients needed revisional surgery in the long-term FU. According to multivariate analysis, drug intake and PMRT were significantly associated with postoperative complications. In Group 2, a thinner subcutaneous tissue was linked to a higher complication risk. Conclusion: In our series, patients treated with PPBR who underwent PMRT, presented a low complication rate and minimal need for revisional surgery in the long-term follow-up, suggesting that this technique is feasible and safe also in PMRT context.

Automated summary

This study analyzed 485 cases of prepectoral breast reconstruction using acellular-dermal-matrix assisted direct-to-implant technique, including 84 cases receiving postmastectomy radiotherapy (PMRT). The results showed that this technique had a low complication rate and minimal need for revisional surgery in the long-term follow-up, indicating its safety and feasibility in the PMRT setting.