LAUSR

BACKGROUND Postmastectomy radiotherapy (PMRT) is associated with altered cosmetic outcomes and higher complication rates in implant-based breast reconstruction (IBR). Conventional wisdom suggests that muscle coverage is somewhat protective against PMRT-related complications. In this study, we compared surgical outcomes in patients who underwent two-stage prepectoral versus subpectoral IBR in the setting of PMRT. METHODS We performed a retrospective cohort study of patients who underwent mastectomy and PMRT with two-stage IBR from 2016 to 2019. The primary outcome was breast-related complications, including device infection; the secondary outcome was device explantation. RESULTS We identified 179 reconstructions (101 prepectoral, 78 subpectoral) in 172 patients with a mean follow-up time of 39.7±14.4 months. There were no differences between the prepectoral and subpectoral reconstructions in rates of breast-related complications (26.7% and 21.8%, respectively; P = .274), device infection (18.8% and 15.4%, respectively; P = .307), skin flap necrosis (5.0% and 1.3%, respectively; P = .232), or device explantation (20.8% and 14.1%, respectively; P = .117). In adjusted models, compared with prepectoral device placement, subpectoral device placement was not associated with a lower risk of breast-related complications (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.41-1.36), device infection (HR, 0.73; 95% CI, 0.35-1.49), or device explantation (HR, 0.58; 95% CI, 0.28-1.19). CONCLUSION Device placement plane was not predictive of complication rates in IBR in the setting of PMRT. Two-stage prepectoral IBR provides safe long-term outcomes with acceptable postoperative complication rates comparable to those with subpectoral IBR, even in the setting of PMRT.