Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy

Abstract

Therapeutic, IV.

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

“…Consequently, well designed clinical trials are needed to support the use of PMRT in the context of emergent prepectoral approaches to breast reconstruction. A retrospective series of 54 patients found comparable complication rates at 19 months after two‐stage prepectoral ADM‐implant reconstruction comprising 45 irradiated and 36 non‐irradiated breasts. Sigalove and colleagues reported a case series of 33 patients (52 reconstructions) over 25 months, with similar conclusions.…”

“…Two recent meta‐analyses reported twofold to threefold higher risks of surgical complications in women undergoing ADM‐implant breast reconstruction combined with radiotherapy. There is a paucity of evidence on the impact of PMRT on prepectoral ADM‐implant reconstruction, with evidence to date comprising small retrospective case series with short‐term follow‐up. There are limited studies comparing clinical outcomes after immediate breast reconstruction using one‐stage direct to implant or two‐stage prepectoral ADM procedures with or without PMRT.…”

“…There are limited studies comparing clinical outcomes after immediate breast reconstruction using one‐stage direct to implant or two‐stage prepectoral ADM procedures with or without PMRT. There are provisional data suggesting potential tolerability of immediate prepectoral ADM‐implant breast reconstruction without excessive risks of complications in the short term. Consequently, well designed clinical trials are needed to support the use of PMRT in the context of emergent prepectoral approaches to breast reconstruction.…”

Fat Grafting in Breast Reconstruction

“…In reconstructions using a bioprosthetic, delayed fat grafting allows time for maximal vascularization of the matrix. [18][19][20][21][22] Delay also facilitates the maturation of contour irregularities, revealing areas of skin thinning and rippling to be targeted during fat grafting, especially in thin women who have limited available donor material. Fat grafting may also be performed over the tissue expander as an interim procedure prior to final implant exchange.…”

Immediate Implant Reconstruction in Patients Undergoing Radiation Therapy: Opportunities and Challenges

“…16,17 Currently, although initial outcomes are promising, there are limited data comparing reconstructive approaches and outcomes for patients undergoing immediate implants versus sub-pectoral expander-based reconstruction. 18,19 Smith et al 20 presented data on 51 patients undergoing immediate implant reconstruction with adjuvant proton therapy. Overall, 8 of the 51 irradiated breasts had reconstruction failure, raising concerns regarding toxicity with this approach.…”