Technical Refinements and Outcomes Assessment in Prepectoral Pocket Conversion After Postmastectomy Radiotherapy

• Published in: Aesthetic surgery journal 2024-05, Vol.44 (6), p.624-632
• Main Authors: Pagliara, Domenico, Rubino, Corrado, Grieco, Federica, Pili, Nicola, Serra, Pietro Luciano, Schiavone, Laurenza, Lattanzi, Melba, Montella, Rino Aldo, Rinaldi, Pierluigi Maria, Ribuffo, Diego, De Santis, Giorgio, Salgarello, Marzia
• Format: Article
• Language: English
• Subjects: Adipose Tissue - transplantation; Adult; Aged; Breast Implantation - adverse effects; Breast Implantation - instrumentation; Breast Implantation - methods; Breast Implants - adverse effects; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Female; Humans; Mastectomy - adverse effects; Middle Aged; Patient Satisfaction; Pectoralis Muscles - surgery; Quality of Life; Radiotherapy, Adjuvant - adverse effects; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
• ISSN: 1090-820X; 1527-330X
• DOI: 10.1093/asj/sjae012

Several studies show how submuscular breast reconstruction is linked to animation deformity, shoulder dysfunction, and increased postoperative chest pain, when compared to prepectoral breast reconstruction. In solving all these life-impairing side effects, prepectoral implant pocket conversion has shown encouraging results. The aim of this study was to propose a refinement of the prepectoral implant pocket conversion applied to previously irradiated patients. We conducted a retrospective study on 42 patients who underwent previous nipple- or skin-sparing mastectomy and immediate submuscular reconstruction, followed by radiotherapy. We performed fat grafting sessions as regenerative pretreatment. Six months after the last fat graft, we performed the conversion, with prepectoral placement of micropolyurethane foam-coated implants. We investigated the preconversion and postconversion differences in upper limb range of motion, Upper Extremity Functional Index, and patient satisfaction with the breast and physical well-being of the chest. We reported a resolution of animation deformity in 100% of cases. The range of motion and the Upper Extremity Functional Index scores were statistically improved after prepectoral implant pocket conversion. BREAST-Q scores for satisfaction with the breast and physical well-being of the chest were also improved. The refined prepectoral implant pocket conversion is a reliable technique for solving animation deformity and improving quality of life in patients previously treated with submuscular reconstruction and radiotherapy.