Complications After Subpectoral and Prepectoral Tissue Expander Placement in Women Undergoing Postmastectomy Radiation Therapy.

IF 1.5 Q3 SURGERY

Plastic and Reconstructive Surgery Global Open Pub Date : 2025-06-23 eCollection Date: 2025-06-01 DOI:10.1097/GOX.0000000000006867

Seamus Caragher, Alisha Paranzino, Stephen Stearns, Libby Copeland-Halperin, Jessica Erdmann-Sager

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Abstract

Background: Placement of tissue expanders is a critical tool in breast reconstruction, particularly with postmastectomy radiation. Prepectoral tissue expander placement has rapidly gained popularity. As such, the precise effects of tissue expander plane selection on outcomes following radiotherapy remain a key question.

Methods: All patients undergoing mastectomy and tissue expander placement followed by radiation at a single center between 2019 and 2021 were retrospectively examined. Clinical, oncological, surgical, and radiation treatment variables, as well as rate of complications before and after radiation, were collected. Multivariate analysis was performed.

Results: The 2 groups had similar baseline clinical and oncological characteristics. Prepectoral placement was more common in bilateral reconstruction and had smaller final tissue expander volume to mastectomy specimen weight ratio. There was no difference in the rate of postoperative or radiation complications based on tissue expander location (17% versus 18%). Multivariable analysis identified acellular dermal matrix as a significant protective factor against perioperative complications (odds ratio [OR]: 0.15; 95% confidence interval [CI]: 0.03-0.78). Increased age and the use of neoadjuvant chemotherapy were significant risk factors for radiation-related complications (age OR: 2.6; 95% CI: 1.02-6.63; Chemo OR: 16.7; 95% CI: 1.55-180).

Conclusions: Prepectoral tissue expander placement can be safely used with postmastectomy radiation. These results highlight acellular dermal matrix use as a major protective factor against complications in these patients. Independently, increased age and the use of neoadjuvant chemotherapy increased the risk of radiation-induced complications. The lack of significant risk with other variables can further assure surgeons of the safe use of prepectoral expanders in radiation-bound patients.

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乳房切除术后放射治疗妇女胸下和胸前组织扩张器放置后的并发症。

背景：组织扩张器的放置是乳房重建的关键工具，特别是在乳房切除术后放疗。胸前组织扩张器的放置已经迅速普及。因此，组织扩张器平面选择对放疗后预后的确切影响仍然是一个关键问题。方法：回顾性分析2019年至2021年间所有接受乳房切除术和组织扩张器放置后单中心放疗的患者。收集临床、肿瘤学、外科和放射治疗变量，以及放射前后的并发症发生率。进行多变量分析。结果：两组患者具有相似的基线临床和肿瘤特征。乳房前放置在双侧重建中更常见，并且最终组织扩张器体积与乳房切除术标本重量比较小。基于组织扩张器位置的术后或放疗并发症发生率没有差异（17%对18%）。多变量分析发现脱细胞真皮基质是预防围手术期并发症的重要保护因素(优势比[OR]: 0.15；95%可信区间[CI]: 0.03-0.78)。年龄的增加和新辅助化疗的使用是放疗相关并发症的重要危险因素(年龄OR: 2.6；95% ci: 1.02-6.63；化疗OR: 16.7；95% ci: 1.55-180)。结论：乳房前组织扩张器放置可安全用于乳房切除术后放疗。这些结果突出了脱细胞真皮基质作为这些患者并发症的主要保护因素。独立地，年龄的增加和新辅助化疗的使用增加了放射引起的并发症的风险。其他变量的显著风险的缺乏可以进一步保证外科医生在辐射限制患者中安全使用直肠扩张器。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and Reconstructive Surgery Global Open SURGERY-

CiteScore

2.20

自引率

13.30%

发文量

1584

审稿时长

10 weeks

期刊介绍： Plastic and Reconstructive Surgery—Global Open is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery.Plastic and Reconstructive Surgery—Global Open publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types. Manuscript submission is open to all surgeons, researchers, and other health care providers world-wide who wish to communicate their research results on topics related to plastic and reconstructive surgery. Furthermore, Plastic and Reconstructive Surgery—Global Open, a complimentary journal to Plastic and Reconstructive Surgery, provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results. Its mission is to disseminate high quality, peer reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As an open access journal, Plastic and Reconstructive Surgery—Global Open offers its content for free to any viewer. Authors of articles retain their copyright to the materials published. Additionally, Plastic and Reconstructive Surgery—Global Open provides rapid review and publication of accepted papers.