Standalone Microthane® breast implants in the prepectoral position: Positive outcomes from combining technical and surgical advantages supported by patient-reported outcomes.

Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular dermal matrix (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation, theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, with a variety of ADMs. The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy of ADM types. The PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type, with a chi-squared test performed for analysis. Identified studies with a comparative group were included in a meta-analysis utilizing risk ratio (RR) to assess the efficacy of ADM. Nine articles including ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion, with a total of 481 breasts. Strattice was the most commonly utilized ADM (n = 391), followed by AlloDerm (n = 57). There was a statistically significant difference in efficacy of ADM among the studied ADM types (P < .001). AlloDerm, FlexHD, and DermaMatrix had the lowest capsular contracture rates (0%). NeoForm and SurgiMend had the highest capsular contracture rates (each 25%, but with n = 4 and n = 8, respectively). Strattice had a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduced the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared with conventional treatment. Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM types. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients when compared to conventional treatment. Future research, especially in the form of randomized controlled trials, is needed to further investigate the efficacy of various ADMs in the treatment of capsular contracture.

Complications and Pattern of Failure Following Immediate Breast Reconstruction after Breast Cancer Surgery: A Retrospective Analysis over Nine Years

Despite 82% of patients reporting psychosocial improvement following breast reconstruction, only 33% patients choose to undergo surgery. Implant reconstruction outnumbers autologous reconstruction in many centres. A systematic review of the literature was undertaken. Inclusion required: (I) Meta-analyses or review articles; (II) adult patients aged 18 years or over undergoing alloplastic breast reconstruction; (III) studies including outcome measures; (IV) case series with more than 10 patients; (V) English language; and (VI) publication after 1(st) January, 2000. After full text review, analysis and data extraction was conducted for a total of 63 articles. Definitive reconstruction with an implant can be immediate or delayed. Older patients have similar or even lower complication rates to younger patients. Complications include capsular contracture, hematoma and infection. Obesity, smoking, large breasts, diabetes and higher grade tumors are associated with increased risk of wound problems and reconstructive failure. Silicone implant patients have higher capsular contracture rates but have higher physical and psychosocial function. There were no associations made between silicone implants and cancer or systemic disease. There were no differences in outcomes or complications between round and shaped implants. Textured implants have a lower risk of capsular contracture than smooth implants. Smooth implants are more likely to be displaced as well as having higher rates of infection. Immediate breast reconstruction (IBR) gives the best aesthetic outcome if radiotherapy is not required but has a higher rate of capsular contracture and implant failure. Delayed-immediate reconstruction patients can achieve similar aesthetic results to IBR whilst preserving the breast skin if radiotherapy is required. Delayed breast reconstruction (DBR) patients have fewer complications than IBR patients. Implant reconstruction is a safe and popular mode of post-mastectomy reconstruction. Evidence exists for the settings in which complications are more likely, and we can now more reliably predict outcomes of reconstruction on an individual basis and assess patient suitability.

Background: Surgical decision-making in breast cancer involves not only clinical and oncological considerations but also psychosocial factors such as personal values, social support, and anticipated quality of life. Although shared decision-making (SDM) is increasingly emphasized, factors influencing patients’ surgical choices remain unclear. This study aimed to identify determinants associated with the selection of total mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR) using patient-reported outcomes. Patients and Methods: A multicenter study was conducted across six institutions in Japan. We included 577 female patients who underwent breast cancer surgery between 2008 and 2018. Using patient-reported outcomes, we collected data on sociodemographic background and 15 decision-influencing factors, including opinions of healthcare providers, family, and peers; radiation therapy; fear of recurrence; hospitalization; and perceived impacts on childcare, work, and hobbies. Patients were categorized into MT, BCS, or IBR groups. Chi-square tests were used for group comparisons, and multinomial logistic regression was performed using the IBR group as the reference. Results: Among 577 patients, 194 underwent MT, 185 BCS, and 198 IBR. The mean age was 53.6 years (±11.5), with the IBR group significantly younger (48.2) than MT (58.1) and BCS (54.8) (p&amp;lt;0.001). The mean interval from surgery to questionnaire response was 56.0 months. IBR patients were more likely to have avoided chemotherapy (p&amp;lt;0.001), be non-smokers (p&amp;lt;0.001), have smaller tumors (p&amp;lt;0.001), no nodal metastasis (p=0.003), and be full-time employed (p&amp;lt;0.001). The incidence of postoperative complications (grade ≥3) was highest in the IBR group (p&amp;lt;0.001). The most reported influence was the surgeon’s opinion (92.2%), followed by fear of recurrence (43.8%), partner’s opinion (35.5%), family (22.4%), and breast cancer survivors (21.0%). Patients influenced by nurses were more likely to select IBR (MT: 3.1%, BCS: 4.5%, IBR: 10.8%; p=0.004). Other significant differences included partner’s opinion (p=0.012), hospitalization (p=0.022), radiation therapy (p&amp;lt;0.001), recurrence fear (p=0.002), and concerns about hobbies (p=0.004) and work (p=0.025). Univariable analysis showed that IBR was more likely in patients who were younger (p&amp;lt;0.001), had smaller tumors (p&amp;lt;0.001), no nodal metastasis (p=0.036), no chemotherapy (p=0.007), were non-smokers (p=0.001), employed full-time (p&amp;lt;0.001), and had higher income (p=0.004). IBR was also associated with influence from nurses (p=0.005), partners (p=0.005), hospitalization (p=0.009), hobbies (p=0.017), and work concerns (p=0.011). Recurrence fear was associated with higher IBR selection over BCS (p=0.017). In multivariable analysis, independent predictors of selecting IBR over both MT and BCS included younger age (p&amp;lt;0.001), non-smoking status (p=0.012), being influenced by nurses’ opinions (p=0.022), and absence of fear of cancer recurrence (p=0.042). Conclusions: This study is the first large-scale, multicenter collaborative study to identify factors influencing surgical decision-making in Japanese breast cancer patients. Predictors influencing the choice of IBR compared with MT and BCS were age, smoking status, nurses' opinions, and anxiety about recurrence. The results of this study suggest the importance of multidisciplinary collaboration and surgical decision-making support that considers the individual background of patients. Citation Format: H. Seki, T. Komiya, M. Kato, Y. Sowa, J. Takano, Y. Nishida, N. Tamura, M. Saiga. Factors influencing surgical decision-making in breast cancer using patient-reported outcomes- A multicenter collaborative study- [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-01-28.

Immediate breast reconstruction with Polyurethane-Coated implants following mastectomy: Early experience and short-term outcomes

Background: The rising utilization of post-mastectomy proton therapy (PMPT) in the setting of breast reconstruction has raised concerns about increased complication rates. There is some limited data indicating PMPT may increase the risk of capsular contracture (CC) when compared with photon therapy. We examined the capsular contracture rate in the largest number of PMPT patients in the literature to date. This study aims to evaluate capsular contracture rates following PMPT and assess the relationship between CC and patient demographics and treatment characteristics. Methods: An IRB approved retrospective study was conducted on breast cancer patients who underwent two stage tissue expander/implant (TE/I) or direct-to-implant (DTI) breast reconstruction and received PMPT between January 2018 and January 2023 at the Miami Cancer Institute, Baptist Health South Florida. Descriptive statistics were used to analyze patient demographics and treatment characteristics. Binary logistic regression was employed to assess the impact of patient and treatment factors on CC development. The Kaplan-Meier method was utilized to evaluate time to CC development. Results: The study cohort comprised 89 patients with 89 reconstructed breasts. The median age was 50 years (24-78). Patient characteristics included 67.4% Hispanic, 10.1% African American, and 68.5% left sided breast cancer. 56.2% underwent total mastectomy, 32.6% had nipple sparing mastectomy, and 11.2% had skin sparing mastectomy. 59.5% of patients had TE at time of PMPT and 40.5% had permanent implant. Tumor characteristics were 89.9% invasive ductal carcinoma, 64% hormone receptor (HR) positive HER2 negative, 15.7% HR positive HER2 positive, 11.2% HR negative HER2 positive, and 9% triple negative. The majority of patients (88.8%) received 50.4 Gy/28 fractions of PMPT (45-56 Gy/25-28 fractions), and 62.9% received neoadjuvant chemotherapy. CC was observed in 51.7% of patients (46 patients), with a mean time to development of 15 months (0.4-152) post-PMPT. Of these 46 patients, 34 underwent surgical intervention, although all were advised to do so. Acute toxicity was observed in 81% of patients, with 62.9% developed grade 2 dermatitis and 5.6% developed grade 3 dermatitis. Logistic regression analysis revealed that DTI significantly increased CC rates compared to TE (OR 3.5, 95% confidence interval 1.4-8.5, p=0.007). No other patient factors were significantly associated with CC development. The mean follow-up was 36 months. At the time of last follow-up, 95.5% of patients were alive and 3.7% have experienced locoregional tumor recurrence. Conclusion: This study demonstrates that breast cancer patients who underwent TE or DTI and received PMPT had an increased risk of CC when compared with photons in the existing literature (50% vs 20%). DTI was associated with a significantly higher risk of CC compared to TE. In the context of PMPT, careful consideration of breast reconstruction modalities and patient discussion is crucial with regard to complication rates. We plan to perform a matched case control study to compare proton vs photon PMRT to further elucidate the CC rate difference. We expect prospective clinical trials to illustrate the increased risk of CC. Citation Format: Mehmet Murat Zerey, Omer Gal, Joseph Panoff. Post-Mastectomy Proton Therapy Imparts Increased Risk of Capsular Contracture in Reconstructed Breast Cancer Patients [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr PS6-03.

Introduction: The rates of adenomastectomy with immediate breast reconstruction (IBR) in patients with breast cancer (BC), in its early stage, are increasing. Lately, the number of patients who undergo radiotherapy (RT) in this scenario has also increased, since patients submitted to mastectomy who present a compromised axillary lymph node already can have clinical benefits from RT. The routine irradiation of muscles in the anterior thoracic wall generates many complications in patients submitted to mastectomy with IBR. In the literature, the local recurrence rate in the general muscle is of approximately 0.6%. The essential point that comes to light is that the 0.6% recurrence rate justifies the routine irradiation of the major pectoral muscle in patients who underwent mastectomy with IBR. The selection of initial BC tumors distant from the major pectoral muscle can eventually spare the pectoral muscle in the planning of the target volume in RT, thus considerably reducing the postoperative complication rates, such as capsular contracture. The ESTRO (European Society for Radiotherapy and Oncology) guidelines recommend sparing the major pectoral muscle, considering the anterior surface of the major pectoral muscle as the dorsal edge in the planning of the target volume of the thoracic wall. The recommendation is: unless the invasion has been demonstrated (tumor stage T4a and T4c), there is no reason to include the major pectoral muscle and the ribs in the thoracic wall in the routine, while planning the target volume. In this context, we elaborated a new radiosurgery model called CHRISTMAS (Chest muscle spaRIng post-MAStectomy radiotherapy). Objective: To elaborate a clinical-surgical model of Sparing Radiotherapy of Major Pectoral Muscle and Anterior Thoracic Wall in patients submitted to adenomastectomy with IBR. Methods: We selected a patient with BR, clinical staging T1N1, more than 2 cm away from the major pectoral muscle, in the Mastology service of Hospital Tacchini. This patient was submitted to adenomastectomy with IBR with expander. Intraoperative radiotherapy with electrons was performed in the nipple-areolar complex, with posterior adjuvant RT of lymph chains through intensity-modulated RT (IMRT), sparing the tissue adjacent to the breast implant (pectoral muscle to nipple level, minor pectoral muscle and anterior thoracic wall). Results: The patient evolved without complications.This new technique has drastically reduced the irradiation rate of the tissue adjacent to the breast implant, besides lungs, pleura and heart. Conclusion: The CHRISTMAS radiosurgery model is technically viable, regarding logistics and radiotherapy planning, and is part of a research project of our institution, in which patients with indication for adenomastectomy, IBR and adjuvant RT with initial BC, distant from the pectoral muscle, will be randomized for conventional RT versus the CHRISTMAS model, comparing the complication and locoregional recurrence rates.

To compare psychosocial function outcomes in early breast cancer patients treated with breast-conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR) at 1year after surgery. Early-stage (stage 0-2) breast cancer patients treated with BCS, MA, and IBR at the University Health Network, Toronto, Ontario, Canada between May 1 2015 and July 31 2016 were prospectively enrolled. Their changes in psychosocial functioning from baseline to 12months following surgery were compared by using the BREAST-Q, Hospital Anxiety and Depression Scale, and Impact of Event Scale with ANOVA and linear regression. There were 303 early-stage breast cancer patients: 155 underwent BCS, 78 MA, and 70 IBR. After multivariable regression accounting for age, baseline score, income, education, receipt of chemoradiation or hormonal therapy, ethnicity, cancer stage, and unilateral versus bilateral surgery, breast satisfaction was highest in BCS (72.1, SD 19.6), followed by IBR (60.0, SD 18.0), and MA (49.9, SD 78.0) at 12months, p < 0.001. Immediate breast reconstruction had similar psychosocial well-being (69.9, SD 20.6) compared with BCS (78.5, SD 20.6), p = 0.07. Sexual and chest physical well-being were similar between IBR, BCS, and MA, p > 0.05. Our study found that in a multidisciplinary breast cancer centre where all three breast ablative and reconstruction options are available toearly breast cancer patients, either BCS or IBR can be used to provide patients with a higher degree of satisfaction and psychosocial well-being compared with MA in the long-term.

Plastic Surgery of the Breast: A 75-Year Journey.

Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction (IBR) is associated with postoperative complications. Although the incidence of node-positive breast cancer is declining, a separate sentinel lymph node biopsy (SLNB) is still performed before mastectomy when IBR is planned, in order to evaluate nodal status and the need for PMRT. This study assessed the impact of staged SLNB on the breast reconstructive planning, and presents common clinicopathological characteristics of breast cancer with macrometastatic nodal spread where staged SLNB would be beneficial to indicate PMRT. Medical records of breast cancer patients scheduled for mastectomy and IBR at Skåne University Hospital, Sweden, from November 2014 to February 2020, were reviewed. Of 92 patients, node-positive disease was present in 15 (16%). Fifty-three patients underwent staged SLNB before mastectomy and IBR, and 10 (19%) presented with nodal metastasis. All patients with macrometastatic sentinel nodes were presented with palpable, multifocal, ER+ breast carcinoma of no special type with tumor size > 17.0 mm. Overall, four women received PMRT after verified metastasis by staged SLNB, and IBR was cancelled for three patients. These findings question the benefit of routine staged SLNB before mastectomy and IBR in breast cancer populations within established mammography screening programs with low risk of nodal metastasis.

In patients with cT1-T3N0 breast cancer, postmastectomy radiation therapy (PMRT) is considered a contraindication for immediate breast reconstruction (IBR) due to a high risk of complications. The sentinel node biopsy (SNB) is an important determinant for PMRT. In this study, we evaluated the impact of SNB outcome on the planning of IBR after mastectomy. Data of patients undergoing mastectomy and SNB in Zuyderland Medical Centre between 2016 and 2019 were retrospectively analysed. Perioperative factors influencing the planning of IBR and SNB results assessed by the intraoperative one-step nucleic acid amplification (OSNA) were registered. Of 397 patients, 169 opted for IBR. One hundred and sevenIBRs were performed: 101 tissue expanders, 5 deep inferior epigastric perforator flaps and 1 latissimus dorsi flap. Eighteen patients (18/107) had macrometastases in the SNB, in six of them IBR was cancelled due to the indication for PMRT (33%). In the other 12 patients IBR was executed as planned. A delayed reconstruction was performed in 59 patients. In breast cancer patients undergoing mastectomy with macrometastases in the SNB, IBR was postponed in 33% due to risk on PMRT. To predict this risk, we advise to acknowledge the SNB outcome by using OSNA before proceeding to IBR.

574 Background: Postmastectomy radiotherapy (PMRT) is the standard treatment for improving the prognosis of patients with high-risk breast cancer. Expanded indications for breast reconstruction (BR) will likely increase the number of patients undergoing BR who require PMRT, but combining BR with PMRT raises concerns about complications and aesthetics. Evaluating the impact of PMRT on the health-related quality of life (HR-QOL) in Japanese patients is essential for shared decision-making (SDM). This study assessed differences in postoperative HR-QOL and complications between patients who underwent BR with or without PMRT. Methods: We conducted a multicenter cross-sectional study using a questionnaire survey of patients with primary breast cancer who underwent BR between January 2008 and December 2022 at participating institutions, which was approved by the respective institutional review boards. We used the Japanese version of the BREAST-Q questionnaire and questions on patient backgrounds. Results: We included 1078 patients with primary breast cancer. The questionnaire response rate was 77.0% (830/1078). The non-PMRT and PMRT groups comprised 616 and 214 patients, respectively. The PMRT group had higher rates of axillary lymph node dissection (11.7% vs. 52.4%; P&lt;0.001), adjuvant hormonal therapy (67.2% vs. 90.6%; P&lt;0.001), and perioperative chemotherapy (31.8% vs. 84.0%; P&lt;0.001) than the non-PMRT group. Moreover, the overall complication rate (45.3% vs. 76.2%, P&lt;0.001) and the rates of dermatitis (9.9 vs. 48.1%; P &lt; 0.001), skin necrosis (2.9 vs. 9.8%; P&lt;0.001), breast asymmetry (17.0% vs. 24.3%; P=0.002), capsular contracture (4.9 vs. 16.4%; P&lt;0.001), and lymphedema of the upper limb (1.1% vs. 7.5%; P&lt;0.001) were higher in the PMRT group. Multivariate analysis revealed PMRT as an independent risk factor for dermatitis, skin necrosis, and capsular contracture. In the BREAST-Q assessment, the PMRT group showed lower satisfaction with the breast (55 vs. 49; P&lt;0.001), and with physical (85 vs. 76; P&lt;0.001), psychosocial (55 vs. 49; P&lt;0.001), and sexual well-being (36 vs. 34; P=0.021) than the non-PMRT group. Multiple regression analysis revealed PMRT as an independent factor associated with low BREAST-Q scores for breast satisfaction and physical and psychosocial well-being in patients with BR. Conclusions: This is the first large-scale, multi-institutional study to use patient-reported outcomes to assess the effects of PMRT on HR-QOL in Japanese patients with breast cancer who underwent BR. PMRT was associated with an increased risk of complications and decreased HR-QOL in patients with BR. Of note, these findings do not negate the role of PMRT in patients undergoing BR, but highlight the importance of SDM based on realistic HR-QOL expectations after breast reconstruction surgery with PMRT.

Introduction: Women considering immediate breast reconstruction (IBR) after mastectomy for breast cancer require high-quality information about the short and long-term clinical outcomes of different procedure types, including the need for further surgery, to allow them to make fully informed decisions about their breast reconstruction options. Long-term outcome data is currently lacking. The UK Brighter population-based cohort study aimed to compare the need for revisional surgery and secondary reconstruction by type of IBR at a minimum of 12 years following the index procedure to support informed decision-making. Methods: Women who underwent unilateral mastectomy and IBR for invasive breast cancer or ductal carcinoma in situ (DCIS) in England between 1 April 2008 and 31 March 2009 were identified using National Health Service (NHS) Hospital Episode Statistics (HES). Lists of procedure codes indicating revisional surgery, defined as operations performed to the same site as the index reconstruction and/or the donor site (if appropriate), excluding a single planned implant exchange in the expander group, or secondary reconstruction, defined as the replacement of one reconstruction with another, with or without a period of being flat, were iteratively developed and refined. Numbers of revision procedures and secondary reconstructions were compared by type of index reconstruction. Multivariable regression was used to control for potential confounders. Results: 2,260 women underwent IBR during the study period including 742 (32.8%) expander/implant (EI), 1,146 (50.7%) latissimus dorsi (LD) flap reconstructions with (n=649) and without (n=497) an implant and 372 (16.5%) abdominal free-flap (AFF) procedures. Women receiving reconstructions involving implants were significantly more likely to require more revisions over time, with 201/742 (27.1%) patients undergoing EI reconstruction and 154/649 (23.7%) those receiving an implant-assisted LD reconstruction requiring two or more post-reconstruction revision procedures compared with 77/497 (15.5%) patients undergoing autologous LD and 59/372 (15.9%) patients receiving AFF procedures (p&amp;lt; 0.001). Undergoing primary reconstructive surgery before the age of 50, and region of residence at the time of the mastectomy were factors influencing revisional surgery in the multivariable regression analysis. By 12 years, 128/742 (17.3%) of women who initially underwent an expander/implant reconstruction had received a secondary reconstruction compared with 34/1146 (3.0%) patients who had initially received an LD +/- implant procedure and 11/372 (3.0%) patients initially undergoing an AFF reconstruction (p&amp;lt; 0.001). Conclusions: The need for revisional surgery in women electing to undergo IBR involving implants is significantly greater than that for women electing to receive autologous reconstructions and almost 1 in 5 women undergoing primary EI reconstruction required a secondary reconstruction by 12 years. These findings should be shared with women considering IBR to support informed decision making and with healthcare providers and commissioners to support the provision of high-quality, evidence-based reconstructive care. Citation Format: Leigh Johnson, Paul White, Ranjeet Jeevan, John Browne, Carmel Gulliver-Clarke, Joe O’Donoghue, Syed Mohiuddin, William Hollingworth, Patricia Fairbrother, Mairead MacKenzie, Chris Holcombe, Shelley Potter. PD15-10 Impact of procedure type on long-term revisional surgery and secondary reconstruction following immediate breast reconstruction: The UK Brighter national population-based cohort study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD15-10.

Quality of life after immediate breast reconstruction and skin-sparing mastectomy – A comparison with patients undergoing breast conserving surgery

Acellular bovine pericardium dermal matrix in immediate breast reconstruction after Skin Sparing Mastectomy