Comparative Analysis of Prepectoral versus Subpectoral Implant-based Breast Reconstruction. Plast Reconstr Surg Glob Open 2021 Jul;9(7):e3709
Date
08/24/2021Pubmed ID
34422525Pubmed Central ID
PMC8376352DOI
10.1097/GOX.0000000000003709Scopus ID
2-s2.0-85112370608 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
UNLABELLED: Recent advances in mastectomy and reconstruction have allowed for an evolution in implant-based breast reconstruction to a muscle-sparing, prepectoral approach. Advantages of this technique may include reductions in postoperative pain, shorter hospitalization, less narcotic usage, and improved aesthetic outcomes. Postoperative complication rates are described as comparable to subpectoral techniques; however, little comparative data exist to adequately assess prepectoral versus subpectoral implant placement.
METHODS: To address this knowledge gap, we performed a single institution retrospective review of 186 (83 prepectoral, 103 subpectoral) consecutive immediate breast reconstructions. All cases were tracked for a minimum of 2 years between 2016 and 2021.
RESULTS: Prepectoral patients demonstrated an overall higher seroma rate (P = 0.001), with all other postoperative complications being comparable. Prepectoral patients tolerated higher intraoperative tissue expander fill volumes (P < 0.001), shorter hospital stays (P = 0.007), fewer clinic visits for tissue expansion (P < 0.001), and experienced less animation deformity (P = 0.005). Both groups demonstrated similar pain scores (P = 0.65) and needs for narcotics (P = 0.8) as well as comparable scores of capsular contracture (P = 0.791).
CONCLUSIONS: Our comparative analysis of consecutive immediate implant-based breast reconstructions finds prepectoral reconstruction to be safe and effective. Compared with subpectoral reconstruction, the prepectoral approach may offer quicker tissue expansion, less postoperative office visits, less need for muscle relaxants, and a shorter hospital stay with a comparable complication profile.
Author List
Plachinski SJ, Boehm LM, Adamson KA, LoGiudice JA, Doren ELAuthors
Erin L. Doren MD Associate Professor in the Plastic Surgery department at Medical College of WisconsinJohn A. LoGiudice MD Professor in the Plastic Surgery department at Medical College of Wisconsin
