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Does pocket location matter? Capsular contracture rates after direct-to-implant reconstruction in patients treated with post-mastectomy radiation therapy.
Shochiro A. Tanaka, MD, MPH
Douglas Wagner, MD
Summa Health, Akron, OH
2019-02-10
Presenter: Shoichiro A Tanaka, MD, MPH
Affidavit:
This project represents a collaboration between the resident and the senior author. Percentage of work as designated below.
Director Name: Douglas Wagner, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: Capsular contracture is a known complication after implant-based breast reconstruction, with reported rates of 10%. When treated with post-mastectomy radiation therapy, rates of capsular contracture have been reported upwards of 70%. We wanted to see if implant pocket location, sub-pectoral vs pre-pectoral, had any impact on incidence of capsular contracture.
METHOD: An IRB-approved retrospective review was performed of a prospectively collected database on all breast reconstruction patients at our institution between the years 2014 – 2017. We excluded patients undergoing delayed or autologous tissue reconstruction. Remaining atients were divided into two groups: Group 1 had a sub-pectoral implant location and Group 2 had a pre-pectoral implant location. We identified demographics, co-morbidities, type of surgery, oncologic treatment, and complication rates. Groups were analyzed using t-test and Fisher's exact tests as appropriate.
RESULT: A total of 95 patients reconstruction between 2014 – 2017. Twenty-four were excluded having undergone delayed or autologous tissue reconstruction. Of the remaining patients, 15 patients received post-mastectomy radiation therapy after direct-to-implant reconstruction. Acellular dermal matrix was utilized on all reconstructions. Demographics and co-morbidities were equivalent. Seven (47%) had a sub-pectoral implant location and 8 (53%) had a pre-pectoral implant location. Incidence of capsular was less in the pre-pectoral group compared to the sub-pectoral group, 25% vs 40%.
CONCLUSION: Post-mastectomy radiation therapy following direct-to-implant breast reconstruction was associated with a decreased incidence of capsular contracture in the pre-pectoral group. Pre-pectoral reconstruction with the use of acellular dermal matrix can be offered to patients who require post-mastectomy radiation therapy.
