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

Marzia Salgarello; Valentina Sara Pino; Federico Taraschi; Giuseppe Visconti; Francesco Cellini; Fabio Marazzi; Valeria Masiello; Liliana Barone Adesi

doi:10.1007/s00266-025-05119-w

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

Aesthetic Plast Surg. 2025 Aug 21. doi: 10.1007/s00266-025-05119-w. Online ahead of print.

Authors

Marzia Salgarello¹, Valentina Sara Pino², Federico Taraschi³, Giuseppe Visconti¹, Francesco Cellini⁴, Fabio Marazzi⁴, Valeria Masiello⁴, Liliana Barone Adesi¹

Affiliations

¹ UO Chirurgia Plastica, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica - Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del "Sacro Cuore" - Largo A. Gemelli 8, 00168, Rome, Italy.
² Università Cattolica del "Sacro Cuore" - Largo A. Gemelli 8, 00168, Rome, Italy. valentina.pino013@gmail.com.
³ Residency Program in Plastic Surgery, Università Cattolica del "Sacro Cuore" - Largo A. Gemelli 8, 00168, Rome, Italy.
⁴ UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia… - Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del "Sacro Cuore" - Largo A. Gemelli 8, 00168, Rome, Italy.

PMID: 40841797
DOI: 10.1007/s00266-025-05119-w

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 .

Keywords: Adjuvant radiotherapy; Breast reconstruction; Polyurethane implants; Prepectoral breast reconstruction.