Revision Surgeries After Proton vs Photon Postmastectomy Radiation Therapy in Prepectoral Implant-Based Breast Reconstruction

Anshumi Desai; Rohan Mangal; Carolina Padilla; Kate McClintock; Seraphina Choi; Juan R Mella-Catinchi; John C Oeltjen; Devinder P Singh; Cristiane Takita; Wrood Kassira

doi:10.1093/asj/sjae216

Revision Surgeries After Proton vs Photon Postmastectomy Radiation Therapy in Prepectoral Implant-Based Breast Reconstruction

Aesthet Surg J. 2024 Oct 21:sjae216. doi: 10.1093/asj/sjae216. Online ahead of print.

Affiliations

¹ Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
² Universidad del Norte, Barranquilla, Colombia.
³ Department of Radiation Oncology, Sylvester Comprehensive Cancer Centre, University of Miami Miller School of Medicine, Miami, FL USA.

PMID: 39431294
DOI: 10.1093/asj/sjae216

Abstract

Background: Postmastectomy radiation therapy (PMRT) improves disease-free survival in breast cancer but reduces aesthetic satisfaction. Proton PMRT has gained popularity due to fewer systemic complications. There is a lack of data regarding revision surgeries for pre-pectoral implant-based breast reconstruction (PP-IBBR) following radiation.

Objectives: To compare the revision surgeries in PP-IBBR with photon versus proton PMRT.

Methods: A single-institution retrospective cohort study included breast cancer patients undergoing mastectomy and PP-IBBR with PMRT (January 2020-October 2022) The mean follow-up duration for the cohort was 1056.4 days (2.89 years). Revision surgeries evaluated were fat grafting, conversion to autologous flaps, implant replacement, implant removal, capsulectomy, and scar revision.

Results: 116 PP-IBBR were divided into two cohorts: photon (75, 64.66%) and proton (41, 35.34%) radiation cohorts. Overall corrective surgeries were higher with photon (27.5% overall; 32.4% photon vs 19.5% proton, p=0.132). The odds of any revision surgery were nearly double with photon (OR=1.98), and the conversion to an autologous flap was significantly more likely with photon (OR=4.55, p=0.025). Multivariable analysis showed an increased tendency for photon therapy patients to require any revision surgeries (OR=1.62, p=0.359), autologous flaps (OR=5.97, p=0.049), fat grafting (OR=1.52, p=0.664) and scar revision (OR=4.51, p=0.273).

Conclusions: Compared to proton therapy, traditional photon therapy has a higher conversion rate to autologous flaps with PP-IBBR. Photon therapy had higher rates of overall revision surgeries, however not statistically significant. Proton therapy is safer, with fewer revision surgeries, warranting larger studies and broader utilization.

© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].