Assessing Long Term Outcomes In Prepectoral Versus Subpectoral Alloplastic Breast Reconstruction
Perri S. Vingan, BS, Kathryn Haglich, MS, Michelle Coriddi, MD, Robert Allen, Jr., MD, Joseph J. Disa, MD, Joseph H. Dayan, MD, Evan Matros, MD, MPH, MMSc, Babak J. Mehrara, MD, Jonas A. Nelson, MD, MPH.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: Tissue expanders (TEs) and implants can be placed using a subpectoral or prepectoral approach. At this time, long term data is needed to more effectively interpret the differences in clinical and patient reported outcomes (PROs) between prepectoral and subpectoral reconstruction.
METHODS: We retrospectively reviewed female patients who underwent TE exchange to implants from 2017 to 2020. Patients had subpectoral or prepectoral reconstruction, along with preoperative and/or 1-2-year postoperative BREAST-Q data. We assessed PROs and complication rates with null hypothesis testing (significant: p<0.05).
RESULTS: 2116 patients were included: 1797 subpectoral and 319 prepectoral. Regarding BREAST-Q scores, prepectoral patients had significantly higher scores than subpectoral patients for physical well-being of the chest preoperatively (p<0.001) and at 1-2-years postoperatively (p=0.003) and for satisfaction with breasts scores at 1-2-years postoperatively. Complications were low overall, but patients with prepectoral devices were more likely to get an infection, seroma, or wound dehiscence (p<0.001, p<0.001, p=0.009, respectively). In a subgroup analysis of radiated patients (neoadjuvant or adjuvant) (n =508; 464 subpectoral, 44 prepectoral), there was no difference between BREAST-Q scores of subpectoral and prepectoral patients. Patients with prepectoral devices were more likely to be affected by seromas (p=0.004) or wound dehiscence (p=0.020).
CONCLUSION: Our preliminary analysis shows that, among patients undergoing alloplastic breast reconstruction, PROs are superior following prepectoral placement. However, the complication profile slightly favors subpectoral reconstruction. Additional long-term analyses should be conducted to better assess the differences between the prepectoral and subpectoral technique.
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