Clinical Outcomes of Prepectoral Breast Reconstruction: A Safe, Less Invasive Option in the Modern Age
Clara Gomez-Sanchez, MD, Rachel Lentz, MD, William Hoffman, MD, Hani Sbitany, MD.
University of California San Francisco, San Francisco, CA, USA.
Purpose: Implant-based reconstruction is the most common method of post-mastectomy breast reconstruction. Based on contemporary outcomes data, submuscular implant placement has been the standard of care because of the lower risk of implant exposure and capsular contracture relative to subcutaneous reconstruction. However, these results were published before the availability of acellular dermal matrices (ADM), which are now commonly utilized for soft tissue support. Prepectoral implant placement with full ADM coverage has emerged as a viable alternative with several benefits over submuscular reconstruction.
Methods: We retrospectively reviewed data from 152 consecutive patients (261 breasts) who completed implant-based reconstruction over three years. Demographics, adjuvant therapies, operative details, and complications were compared between prepectoral and submuscular reconstructions.
Results: 62 patients (102 breasts) and 90 (159 breasts) underwent prepectoral and submuscular implant placement, respectively. 17 breasts in the prepectoral group were irradiated and 25 in the submuscular group. There was no significant difference between the groups in demographics, total complications, readmissions, capsular contracture, prosthetic loss, wound breakdown, or infection requiring IV antibiotics. There was a significantly higher rate of unplanned reoperation in the submuscular group (39.6% vs 24.5%) and rate of cellulitis requiring PO antibiotics in the prepectoral group (17.6% vs 6.3%). Mean follow up after reconstruction was 17.3 months in the submuscular group and 10.7 in the prepectoral. There was no significant difference in complications between groups in patients who underwent radiation.
Conclusions: Prepectoral reconstruction with full ADM coverage is an excellent alternative to submuscular implant placement even in patients who undergo radiation.
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