Technical Refinements and Outcomes Assessment in Prepectoral Pocket Conversion After Postmastectomy Radiotherapy.

BACKGROUND: Several studies show how submuscular breast reconstruction is linked to animation deformity, shoulder disfunction and increased postoperative chest pain, when compared to prepectoral breast reconstruction. In solving all these life-impairing side effects, prepectoral implant pocket conversion has shown encouraging results.

OBJECTIVES: The aim of our study is to propose a refinement of the prepectoral implant pocket conversion applied to previously irradiated patients.

METHODS: We conducted a retrospective study on 42 patients who underwent previous nipple or skin-sparing mastectomy and immediate submuscular reconstruction, followed by radiotherapy. We performed fat grafting sessions as regenerative pretreatment. Six months after the last fat graft, we performed the conversion with prepectoral placement of micropolyurethane foam coated implants. We investigated the pre-conversion and post-conversion differences in upper limb Range of Motions, Upper Extremity Functional Index, Satisfaction with Breast and Physical Well-Being Chest.

RESULTS: We reported a resolution of animation deformity in 100% of cases. The Range of Motions and the Upper Extremity Functional Index scores were statistically improved after prepectoral implant pocket conversion. Q-scores for Satisfaction with Breast and Physical Well-Being Chest were also increased.

CONCLUSIONS: The prepectoral implant pocket conversion refined is a reliable technique to solve animation deformity and improve quality of life in patients previously treated with submuscular reconstruction and radiotherapy.