American Association of Plastic Surgeons

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Impact of Animation Deformity on Patient-Reported Breast Reconstruction Outcomes: A Subpectoral vs Prepectoral Planes Comparison
Ryoko Hamaguchi, MD, Olivia Abbate Ford, MD, Nicholas Leung, BS, Tanujit Dey, PhD, Yoon S Chun, MD
Brigham and Women's Hospital, Boston, MA, USA

PURPOSE:
The ideal plane for implant-based breast reconstruction (IBR) has gained increased attention as prepectoral reconstruction became popularized to avoid animation deformity (AD) typically associated with subpectoral reconstruction. Prepectoral IBR is limited by mastectomy flap quality with potentially higher complication risks, with minimal data on the effect of AD on overall breast reconstruction satisfaction. This study evaluates the impact of AD on patient-reported outcomes (PRO) by comparing two-stage prepectoral vs. subpectoral reconstruction.
METHODS:
In this retrospective study, patients who completed two-stage IBR were divided into prepectoral or subpectoral groups and demographics, co-morbidities, and complication data were collected. Eligible patients were asked to complete the BREAST-Q Animation Deformity scale and Reconstruction-Postoperative modules. Mean and standard deviation were used to report descriptive statistics. A t-test was used to assess differences in scores between the two groups.
RESULTS:
Among 82 patients, 33 and 49 patients underwent prepectoral and subpectoral IBR, respectively, with comparable complications and revision rates. As expected, the subpectoral cohort had a lower Animation Deformity Scale score compared to prepectoral (7219 vs. 8315, p=0.004), consistent with greater AD. Interestingly, despite the difference in AD PRO, there was no significant difference in BREAST-Q scores for Satisfaction with Breasts (p=0.3), Physical Well-Being: Chest (p=0.8), or Satisfaction with Implants (p=0.065). Psychosocial Well-Being and Sexual Well-Being scores were higher in the prepectoral cohort (p=0.019 & p=0.009 respectively).
CONCLUSION:
Although AD is associated with subpectoral IBR, it does not appear to impact overall breast reconstruction satisfaction. Prepectoral IBR had higher psychosocial and sexual well-being scores.


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