OBJECTIVE: Implant-based breast reconstruction (IBR) is being increasingly performed with implant placed above the pectoral muscle (pre-pectoral), instead of below the pectoral muscle (sub-pectoral). Currently, there is a lack of comparative data on clinical and patient-perceived outcomes between pre- vs. sub-pectoral IBR. We investigated whether this difference in surgical approach influenced clinical or patient-perceived outcomes.
METHODS: This prospective non-randomised longitudinal cohort study (ClinicalTrials.gov identifier: NCT04842240) recruited patients undergoing immediate IBR at the Leeds Breast Unit (Sep 2019-Sep 2021). Data collection included patient characteristics and post-operative complications. Patient-Reported Outcome Measures were collected using the BREAST-Q questionnaire at baseline, 2 weeks, 3- and 12-months post-surgery.
RESULTS: Seventy-eight patients underwent IBR (46 patients pre-pectoral; 59% vs. 32 patients sub-pectoral; 41%). Similar complication rates were observed (15.2% pre-pectoral vs. 9.4% sub-pectoral; p = 0.44). Overall implant loss rate was 3.8% (6.5% pre-pectoral vs. 0% sub-pectoral; p = 0.13). Respective median Breast-Q scores for pre- and sub-pectoral IBR at 3 months were: breast satisfaction (58 vs. 48; p = 0.01), psychosocial well-being (60 vs. 57; p = 0.9), physical well-being (68 vs. 76; p = 0.53), and Animation Q scores (73 vs. 76; p = 0.45). Respective Breast-Q scores at 12 months were: breast satisfaction (58 vs. 53; p = 0.3), psychosocial well-being (59 vs. 60; p = 0.9), physical well-being (68 vs. 78; p = 0.18), and Animation Q scores (69 vs. 73; p = 0.4).
CONCLUSIONS: This study demonstrates equivalent clinical and patient-perceived outcomes between pre- and sub-pectoral IBR. The study findings can be utilised to aid informed decision making regarding either surgical option.

UNASSIGNED: The risk factors for breast implant reconstruction complications and prosthetic reconstruction failure are currently inconclusive. Besides, there is a lack of studies regarding the relationship between radiation dose distribution and complications. This study explored the risk factors for breast implant reconstruction complications and analyzed the influence of radiation dose distribution on complications.
UNASSIGNED: Patients undergoing breast prosthesis reconstruction between January 2012 and June 2020 were retrospectively reviewed. Patient demographics, treatments, and perioperative factors were recorded, as well as complications and prosthetic reconstruction failures. Multivariable logistic regression models were used to explore the risk factors of reconstruction complications and prosthesis reconstruction failure. The radiation dose distribution was obtained by examining the dose-volume histogram and compared among patients with and without complications.
UNASSIGNED: Two hundred and sixteen patients (221 reconstructions) were not irradiated, whereas 59 (59 reconstructions) received radiotherapy (RT). The median follow-up period was 47.7 months. Multivariate regression analysis showed that RT [odds ratio (OR) =2.000; 95% confidence interval (CI): 1.065-3.754; P=0.031] and chemotherapy (OR =2.226; 95% CI: 1.032-4.799; P=0.041) were independent risk factors for overall reconstruction complications; and hypertension (HT) (OR =8.222; 95% CI: 1.056-64.034; P=0.044) or RT (OR =2.442; 95% CI: 1.009-5.908; P=0.048) were risk factors for prosthetic reconstruction failure. There was a statistically significant difference in the radiation dose distribution between patients with and those without complications. Patients with complications had a significantly higher mean dose of 5 or 10 cc around the maximum radiation dose in the planning target volume (PTV) (P=0.045 and P=0.034, respectively), irradiation volume with a dose of 107% of prescription dose (P=0.027), and proportion of irradiation volume with doses of 105% and 107% of prescription dose to the total PTV (P=0.019 and P=0.042, respectively).
UNASSIGNED: RT can increase implant reconstruction complications and prosthetic reconstruction failure, but remains an acceptable option in a multidisciplinary setting. In addition to RT, chemotherapy is a risk factor for overall complications of breast implant reconstruction. HT is a risk factor for prosthetic reconstruction failure, so the patient\'s blood pressure should be actively monitored and controlled during the perioperative period. The radiation dose level and the volume with high-dose radiation should be limited to reduce complications.

The widespread use of silicone implants in reconstructive and aesthetic breast surgery led to an increase in the incidence of breast implant associated anaplastic large cell lymphoma, BIA-ALCL, mainly associated with the use of macro-textured breast implants. BIA-ALCL is a serious complication presenting clinically as a late onset periprosthetic seroma. Thus, its occurrence became an alarming sign feared by most plastic surgeons. Therefore, a good knowledge with respect to early diagnosis, subsequent workup, and treatment is crucial in the management of periprosthetic seroma. The diagnosis of late onset seroma is clinically evident. Although idiopathic seroma is the most common cause, BIA-ALCL should be always eliminated. A complete workup is usually necessary. An ultrasound performed by a radiologist specialized in breast imaging followed by an ultrasound guided puncture is imperative. Consequently, the cytological and the bacteriological analysis will orient us toward the etiology (infectious, neoplastic or mechanical). A standardized management of late periprosthetic seroma does not exist, with various factors are to be taken into consideration. These include the surgeon\'s experience, the diagnosis, and the medical institution facilities. Although idiopathic seroma is managed by a simple puncture and drainage, other causes may require a surgical procedure with implant removal, capsulotomies, and/or total capsulectomies.

Preoperative breast volume estimation is very important for the success of the breast surgery. In this study four different breast volume determination methods were compared. The end-point of this prospective study was to evaluate the concordance between different modalities of breast volume assessment (MRI, BREAST-V, mastectomy specimen weight, conversion from weight to volume of mastectomy specimen) and the breast prosthetic volume implanted. The study enrolled 64 patients between 2017 and 2019, who had all been treated by the same surgeons for monolateral nipple-areola complex-sparing mastectomy and implant breast reconstruction. Only patients who had a breast reconstruction classified as \"excellent\" from an objective (BCCT.core software) and subjective (questionnaire) point of view at the 6-month interval after the operation were included in the study. Data analysis highlighted a strong correlation between the volumes of the chosen prostheses and the weights of mastectomy converted into volume, especially for patients with grades B and C parenchymal density. The values of the agreement between the volumes of the chosen prostheses and the assessments from MRI and BREAST -V proved to be lower than expected from the literature. None of the four studied methods presented any strong correlation with the initial breast width. Our results suggest that conversion from weight to volume of mastectomy specimen should be used to assist in determining the volume of the breast implant to be implanted. This method would help the reconstructive surgeon guide the choice of the most appropriate implant preoperatively.

In this study we evaluated how the timing of chemotherapy for breast cancer affects post-reconstruction complications to determine whether there is an optimal time for breast reconstruction after chemotherapy.
A retrospective review identified 344 breast cancer patients who underwent chemotherapy with mastectomy and autologous/prosthetic reconstruction from 2011 to 2014. A control group of 127 breast cancer patients who underwent mastectomy and autologous/prosthetic reconstruction without chemotherapy was also identified from the same period. The 2 groups were compared and analyzed for differences in demographic characteristics, treatment, and postoperative complication rates. The chemotherapy group was subsequently stratified into 3 subgroups on the basis of the number of days between chemotherapy treatment and reconstructive surgery (≤ 30 days, 30-60 days, > 60 days) for further analysis.
Patients who received chemotherapy were followed for an average of 803.4 days (26.4 months) from the time of initial reconstruction (mean time to complication, 43.3 ± 82.7 days), and experienced an overall greater complication rate compared with control subjects (32.8% vs. 24.4%; P = .078). When complications were divided into minor, major, and reconstructive failure categories, analysis revealed that the chemotherapy group experienced more minor complications than the control group (18% vs. 11%; P = .067). However, there were no statistically significant differences in major complication rates (10.5% vs. 9.4%) and reconstructive failure complication rates (3.8% vs. 2.4%) between the chemotherapy group and control group. Sixty-eight patients (19.8%) underwent surgery within 30 days of chemotherapy, 210 patients (61%) within 30 to 60 days, and 66 patients (19.2%) after 60 days. Of note, patients in the ≤ 30 days group underwent surgery at a mean time of 24.8 days with 2 patients who underwent surgery in < 15 days. The 3 groups did not differ with respect to demographic factors or breast reconstructive modality, and there were no significant differences in overall complication rates (33.8% for ≤ 30 days, 31.4% for 30-60 days, and 36.4% for > 60 days), time to complication, complication severity, or complication type. Whereas patients who underwent surgery 30 to 60 days from the time of chemotherapy had lower rates of skin necrosis (3.8%) and infection (15.7%) compared with the ≤ 30 days and 60 to 90 days groups, this finding was not statistically significant.
Results of this study suggest that chemotherapy does increase overall breast reconstruction complications, however, a decreased time between chemotherapy and surgical reconstruction does not predispose patients to postoperative complications. Consequently, surgery might be feasible in close temporal proximity to chemotherapy administration.