The Impact of Postmastectomy Radiation Therapy on Immediate Prepectoral Reconstruction with Polyurethane-Coated Implants

Abstract Background Increasingly popular, prepectoral breast reconstruction preserves the pectoralis major muscle’s anatomy and function. Although polyurethane-coated implants in this context have yielded encouraging results, their interplay with postmastectomy radiation therapy (PMRT) is not well-documented, particularly considering PMRT's known adverse effects on implant-based reconstructions. The study aimed to evaluate the aesthetic outcomes and radiation therapy (RT) damage in patients undergoing prepectoral reconstruction with polyurethane-coated implants receiving PMRT, as well as the influence of mastectomy flap thickness on RT side effects. Methods In 47 patients receiving immediate breast reconstruction with prepectoral polyurethane-coated implants followed by PMRT, aesthetic results were assessed using the Likert scale, and RT damage was scored with the LENT–SOMA scale. The study retrospectively analyzed the impact of different RT techniques (3D vs. IMRT) and examined the correlation between mastectomy flap thickness and RT adverse effects. Results At 12-month follow-up, the mean Likert score for patients treated with IMRT/VMAT was 13.06 (SD: 2.55) compared to 11.79 (SD: 2.37) for those treated with the 3D technique. LENT–SOMA scores were 1.46 (SD: 1.13) for IMRT/VMAT and 3.11 (SD: 1.41) for 3D. A negative linear correlation was found between mastectomy flap thickness and RT damage. Conclusions Preliminary findings are favorable for the use of prepectoral polyurethane-coated implants in immediate breast reconstruction with PMRT, particularly when using IMRT and in patients with thicker mastectomy flaps. Level III, therapeutic study. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .