Objective: To preserve the mastectomy skin envelope in select patients destined to receive radiation following mastectomy, we performed immediate tissue expander-implant reconstruction with a subpectoral tissue expander and an inferolateral AlloDerm hammock for complete implant coverage. We hypothesized that the AlloDerm hammock may allow greater intraoperative volume expansion and potentially avoid the need for an autologous construct.

Methods: Tissue expanders were filled to 75%-85% capacity intraoperatively and 85%-100% prior to radiation therapy. This allowed for maximum preservation of the mastectomy skin envelope prior to radiation therapy and provided a sizable breast mound immediately following mastectomy. Histology of irradiated and nonirradiated capsules was compared.

Results: Five patients aged 29-51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation 2-6 months following the procedure. Patients were followed for 2.5-5.5 years following implant reconstruction and 2-5 years following radiation. No capsular contracture or implant loss was observed in any patient. No patients required or requested autologous reconstruction following radiation and all currently have silicone implants. Capsular biopsies from radiated and nonradiated implants showed identical collagen architecture on histology, confirming clinical observations.

Conclusion: Tissue expander-implant breast reconstruction following mastectomy preserves the skin envelope in patients who receive postmastectomy radiation. Further investigation is warranted to determine whether complete implant coverage with the pectoralis muscle and AlloDerm hammock mitigates the deleterious effects of radiation.