The Effect of Flap Thickness on Major Complications of Prepectoral Breast Reconstruction Without Using ADM in Radiotherapy Patients

Abstract

Objectives: Recent studies have started to question the need for acellular dermal matrix (ADM) in immediate implant-based prepectoral breast reconstruction. However, most of the patients in these studies did not receive postoperative radiotherapy. In this study, it was aimed to investigate the major complication rate after immediate prepectoral breast reconstruction without the use of ADM and to find the optimal cutoff value of the mastectomy flap thickness. Methods: Patients who underwent immediate prepectoral breast reconstruction and received postoperative radiotherapy between 2020 and 2022 were included in this retrospective study. The correlation between mastectomy flap thickness and major complications was investigated. Results: A total of 77 patients, corresponding to 81 breasts were included in this study. Major complications were encountered in 18 (22%) breasts. The thickness of mastectomy flaps ranged from 0.31 mm to 1.2 cm, with an average thickness of 6.6 ± 2.1 mm. No capsule contracture was encountered in any of the patients during the follow-up period (21.1 ± 4.3 M). A flap thickness of ≤5.5 mm is the cutoff value for developing major complications in patients who will receive radiotherapy ( P < .05). Conclusion: Immediate prepectoral breast reconstruction without using ADM is a reliable and safe method for breast reconstruction. However, if radiotherapy is planned, care must be taken when mastectomy flap thickness is equal or below 5.5 mm to avoid major complications. Prepectoral reconstruction with transverse mastectomy incision provides the ability to complete the reconstruction in a single session with a high cost-effective way.