R. E. Weitzman1, N. Sobti1, K. P. Nealon1, A. S. Colwell1, W. G. Austen1, E. C. Liao1 1Massachusetts General Hospital,Division Of Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction: Breast cancer is one of the most common cancers to affect women, and implant-based breast reconstruction accounts for more than 80% of reconstruction cases, with over 100,000 procedures performed in the US per year. One of the most common problems after implant-based breast reconstruction occurs after post-mastectomy radiation therapy (PMRT). Breast implants are usually placed in the subpectoral plane, but we and others have innovated muscle-sparing prepectoral implant placement. This study tests the hypothesize that prepectoral breast reconstruction is associated with lower incidence of capsular contracture when compared to subpectoral placement in an irradiated patient population.
Methods: Retrospective chart review was conducted to identify consecutive procedures performed at a tertiary academic medical institution over 4 years. Patients who had either pre-operative or post-operative radiation therapy were included. Univariate and penalized logistic regression analyses were conducted to compare clinical endpoints across the implant positioning groups.
Results: Rate of capsular contracture was significantly greater in the subpectoral group compared to the prepectoral group [n = 14 (9.5%) v. n = 0 (0.0%), respectively, p = 0.04]. Penalized logistic regression revealed that subpectoral implant placement was nearly 3 times as likely to result in capsular contracture when compared to prepectoral breast reconstruction within an irradiated population, although the result did not achieve statistical significance. Rates of revision, explantation, infection, tissue necrosis, and hematoma were comparable between groups.
Conclusion: This study compares capsular contracture rates between prepectoral and subpectoral breast reconstruction groups in an irradiated patient population. The results suggest that prepectoral implant breast reconstruction is associated with lower rate of capsular contracture after breast irradiation when compared to subpectoral reconstruction. This data supports the hypothesis that implant coverage by skeletal muscle tissue in subpectoral breast reconstruction could predispose the breast to prosthesis deformity and contracture after radiation as the muscle undergoes fibrosis. Prepectoral breast reconstruction technique excludes the pectoralis muscle from the reconstruction soft tissue, mitigating post-radiation deformity and reducing capsular contracture.
