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• W3163462637 abstract "PURPOSE: Prepectoral breast reconstruction has been shown to be similar in clinical outcomes to the subpectoral approach, while eliminating animation deformity and decreasing postoperative pain, loss of strength, operating times, and hospital stays. Although many of these patients undergo adjuvant radiation therapy (XRT), which is well-known to increase the risk of all complications following reconstruction, there are limited data on outcomes and safety of prepectoral breast reconstruction in this setting. The purpose of this study was to compare the clinical outcomes of prepectoral versus subpectoral 2-stage implant-based breast reconstruction in patients undergoing adjuvant XRT. METHODS: We conducted a retrospective review of all consecutive 2-stage implant-based breast reconstructions performed at our institution during a 22-month period from September 2016 to July 2018, with a minimum follow-up of 10 months. Patients who received adjuvant XRT were identified, and 2 cohorts were created: those who underwent prepectoral versus subpectoral breast reconstruction. We collected data including patient demographics, operative variables, and clinical outcomes. Univariate analyses and multivariate logistic regression were conducted, with statistical significance set as P < 0.05. RESULTS: We captured 313 patients, or 492 breasts, who had undergone 2-stage reconstruction. Of those, 69 breasts received adjuvant XRT. Twenty-eight were reconstructed prepectorally, and 41 breasts subpectorally. The 2 cohorts were well matched, with no differences in age, body mass index, smoking, mastectomy location, need for lymph node biopsy, mastectomy specimen weight, or use of incisional wound vacuum (P > 0.05). The prepectoral cohort had a higher rate of diabetes (14.3% versus 0.0%, P = 0.02). We detected no differences in clinical outcomes between the 2 groups (prepectoral versus subpectoral, P > 0.05), including rate of return to the operating room (OR), capsular contracture, explantation, necrosis of the nipple or skin, infection, hematoma, seroma, dehiscence, or readmission. There, however, were differences in certain perioperative variables. Prepectoral reconstruction was associated with a shorter time in the OR (257.0 versus 325.6 minutes; P = 0.006), shorter length of stay (1.0 versus 1.4 days; P = 0.02), higher cost ($28391.7 versus $23316.7; P = 0.03), and shorter time to final reconstruction (320.2 versus 422.7 days; P = 0.04). Multivariate logistic regression demonstrated that prepectoral reconstruction does not predict likelihood of developing a complication (odds ratio, 0.63; CI, 0.21–1.83; P > 0.05). CONCLUSIONS: We found that prepectoral reconstruction is safe in the setting of adjuvant XRT, with similar rates of all complications as compared with subpectoral reconstruction. To our knowledge, this is the largest cohort of radiated prepectoral 2-stage breast reconstructions to be studied. Although radiation is a known risk factor for all complications following breast reconstruction, we did not find device location to influence complication rate in this high-risk population. Importantly, although rate of capsular contracture is reported to be higher in the general prepectoral population, we did not find this to be true in our radiated population. Prepectoral reconstruction is associated with higher OR cost; however, this cost may be recuperated with the overall shorter length of stay. Aesthetic outcomes were not considered but will be studied prospectively in future studies." @default.
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• W3163462637 date "2020-09-01" @default.
• W3163462637 modified "2023-10-16" @default.
• W3163462637 title "Prepectoral Breast Reconstruction Is Safe in the Setting of Adjuvant Radiation Therapy" @default.
• W3163462637 doi "https://doi.org/10.1097/01.gox.0000720360.67149.9d" @default.
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