Abstract PS1-23: Pre-pectoral implant-based reconstruction and adjuvant radiation therapy - Surgical outcomes from a multicentre study in United Kingdom
Authors: Chandarana Mihir , Narayanan Sankaran , Parmeshwar Rishikesh 
Published: February 2021

BackgroundPre-pectoral implant-based reconstruction is the most common form of reconstruction performed in the United Kingdom (UK) after a mastectomy. Implant-based reconstruction is relatively contraindicated in patients known to require adjuvant radiation therapy. There is limited data on surgical outcomes in patients with pre-pectoral implant-based reconstruction who received adjuvant chest wall radiotherapy. We present early post-operative outcomes of in this subset of patients in a large multicentre audit on prepectoral implant based reconstruction.

MethodsA retrospective multi-centre audit of all post-mastectomy prepectoral breast reconstruction (PBR) using Braxon® acellular dermal matrix was conducted. The demographic details, treatment details, 90-day complication rates and implant loss rates for the entire study period were evaluated. A subset analysis of patients who required adjuvant radiation therapy was performed. Complications were categorized as major and minor based on the Clavien-Dindo classification. All complications grade III or higher were regarded as major complications. Complications reported after 90 days of the reconstruction, were regarded as delayed complications. Implant loss rates were compared to the subset of patients who did not receive adjuvant radiation therapy.

ResultsEight hundred and twenty two patients underwent 1020 post-mastectomy PBR across 29 centres in the UK from January 2014 to 2019. Of these, 166 (16.28%) reconstructions received adjuvant radiation therapy. Median follow-up period was 18 months for this cohort. Median age was 49 years and the median body mass index was 25 kg/m2. Fifty-six (33.73%) patients had an axillary nodal clearance. Median hospital stay was 1 day. One hundred and twenty eight (77.11%) patients had a single stage reconstruction and 93 (56%) patients received adjuvant chemotherapy. The 90-day major complication rate was 16.26%, readmission rate and return to theatre rate was 14.45% each. Delayed complications were reported in 8.43% patients. The implant loss rate was 7.83% for the entire study period. This was comparable to the implant loss rates in the subset of patients without adjuvant radiation therapy (p = 0.366). Patients with a 2-stage reconstruction had a higher major complication rate (22.71%) as compared to single stage reconstruction (16.40%), which was statistically not significant (p = 0.469).

ConclusionImplant-based PBR with acellular dermal matrix has comparable outcomes in patients undergoing adjuvant radiation therapy in terms of early outcomes. Patient reported outcomes need to be evaluated along with incidence of capsular contractures and the possible needs for additional delayed surgical interventions in this group of patients. Larger studies are needed to confirm the findings and the impact of radiotherapy in PBR.

CharacteristicNumber of patients or proceduresTotal number of procedures1020Procedures with adjuvant radiation therapy166 (16.27)Age (years)49BMI (kg/m2)25Management of axilla Axillary nodal clearance56 (33.73)Type of reconstructionOne-stage128 (77.11)Two-stage22 (13.25)Missing16 (9.64)Hospital stay (days)1 (0-10)Breast specimen weight (grams)452 (108-1578)Implant size (cc)400 (130-700)Adjuvant chemotherapy93 (56.02)

Citation Format: Mihir Chandarana, Sankaran Narayanan, Rishikesh Parmeshwar. Pre-pectoral implant-based reconstruction and adjuvant radiation therapy - Surgical outcomes from a multicentre study in United Kingdom [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-23.