American Association of Plastic Surgeons

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Tissue Expander Based Breast Reconstruction in the Prepectoral vs. Subpectoral Plane: An Analysis of Complications, Costs, and Post-Operative Course
Halley Dararch, BS, Franca Kraenzlin, MD, Nima Khavanian, MD, George Kokosis, MD, Justin Sacks, MD, MBA.
Johns Hopkins, Baltimore, MD, USA.

Purpose:
The availability of tissue replacement matrix has ushered in a revival of prepectoral tissue expander (TE) placement. Studies have already demonstrated many benefits of prepectoral reconstruction and we aimed further examine the outcomes of patients undergoing immediate breast reconstruction with TEs with respect to anatomic placement.
Methods:
An IRB approved retrospective review of all adult post-mastectomy patients receiving TEs was completed for a one-year period (2017) at an academic medical center (n=178). Patient demographics, operating room charges, anesthesia length, length of hospital stay, post-operative complications, and average time to reconstruction were compared through a review of the medical records.
Results:
A total of 178 patients underwent mastectomy followed by TE placement. The number of patients receiving prepectoral TEs compared to subpectoral TEs were split exactly at 50% (n=89). Individuals with a prepectoral TE underwent definitive reconstruction 39.4 days earlier than individuals with subpectoral TE placement (154.2 days vs. 193.7 days, p=0.01, respectively). Complication rates were similar between the patient groups. Anesthesia time was significantly less for prepectoral TE placement, whether bilateral (56.8 less minutes, p=<0.001) or unilateral (30.8 minutes less, p=<0.001). Operating room cost has higher in the prepectoral subgroup ($30,997.3 vs. 22,204.1, p-<0.001, respectively), with the largest contributor to the cost difference stemming from the amount of tissue replacement matrix used.
Conclusion:
Prepectoral tissue expander based reconstruction is a safe alternative to subpectoral reconstruction with patients benefiting from less anesthesia time and shorter time to definitive reconstruction, at the compromise of higher operating room costs.


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