Case-Control Study of Pre- versus Subpectoral Breast Reconstruction among Patients Receiving Adjuvant Radiation Therapy
Chao Long, MD, Franca Kraezlin, MD, George Kokosis, MD, Pathik Aravind, MBBS, Justin M. Sacks, MD, MBA, Gedge D. Rosson, MD.
Johns Hopkins Hospital, Baltimore, MD, USA.
Background: 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. However, many patients undergo adjuvant radiation therapy (XRT), and outcomes following preprectoral breast reconstruction in this setting is largely unknown. The purpose of this study was to compare clinical outcomes of pre- to subpectoral breast reconstruction in patients undergoing adjuvant XRT.
Methods: We conducted a retrospective review of all consecutive two-staged breast reconstructions performed at our institution during a 22-month period, with a minimum follow-up of 10 months. Patients who received adjuvant XRT were identified, and two cohorts were created: those who underwent pre- vs. subpectoral breast reconstruction. We collected data including patient demographics, operative variables, and clinical outcomes. Univariate and multivariate analyses were conducted, with statistical significance set as p <0.05.
Results: We captured 313 patients, or 492 breasts, that had undergone two-stage reconstruction. Of those, 69 breasts had undergone adjuvant XRT. Twenty-eight were reconstructed prepectorally, and 41 breasts subpectorally. The two cohorts were well matched, with no differences in age, body mass index, smoking, mastectomy location, need for lymph node biopsy, mastectomy specimen weight, use of incisional wound vacuum, or type of final reconstruction. There were more diabetics in the prepectoral cohort (14.3% vs. 0.0%, p=0.02).
We detected no differences in clinical outcomes between the two groups (prepectoral vs. subpectoral, p>0.05), including rate of return to the operating room (OR), 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 vs. 325.6 minutes, p=0.006), shorter length of stay (LOS) (1.0 vs. 1.4 days, p=0.02), higher cost ($28,391.7 vs. $23,316.7, p=0.03), and shorter time to final reconstruction (320.2 vs. 422.7 days, p=0.04).
Multivariate logistic regression demonstrated that prepectoral reconstruction does not predict likelihood of developing a complication (OR 0.63, CI 0.21-1.83, p>0.05).
Conclusions: To our knowledge, this is the largest cohort of radiated prepectoral breast reconstructions. We found that prepectoral reconstruction is safe in the setting of adjuvant XRT, with similar rates of all complications as compared to subpectoral reconstruction. Although prepectoral reconstruction is associated with higher OR cost, it decreases operative time, LOS, and time to final reconstruction. Aesthetic outcomes were not considered but will be studied prospectively in future studies.
Back to 2019 Posters