Planning Pre-pectoral Implant-Based Breast Reconstruction When Confronted with XRT

Implant-based reconstruction is the most common form of breast reconstruction. Although this has been considered questionable in the face of radiation therapy, advancements both in radiation technology and the use of ADM and fat grafting have made the pre-pectoral approach in one or two stages a safe reconstructive procedure in radiation setting. In previously irradiated patients requesting reconstruction, the decision as to whether implant-based reconstruction is feasible depends on thorough examination of their tissues for clinical signs of radiation damage. In the era of autologous fat transfer (AFT), implant-based reconstruction may be performed even in patients whose tissues have been damaged by radiation therapy, by first regeneration the tissue with fat grafting and then, inserting an implant or tissue expander for completion of the reconstruction process.