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American Association of Plastic Surgeons

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Pre-pectoral Or Sub-pectoral Tissue Expander-based Breast Reconstruction - A Propensity-matched Analysis Of Clinical And Health Related Quality Of Life Outcomes
Jonas A. Nelson, MD1, Meghana G. Shamsunder, MPH1, Thais O. Polanco, MD1, Hanna Slutsky, BS2, Robert J. Allen, Jr., MD1, Collen M. McCarthy, MD, MS1, Evan Matros, MD1, Michelle Coriddi, MD1, Joseph H. Dayan, MD1, Peter G. Cordeiro, MD1, Babak J. Mehrara, MD1, Andrea L. Pusic, MD3, Joseph J. Disa, MD1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Memorial Sloan Kettering, New York, NY, USA, 3Brigham and Women's Hospital, Boston, MA, USA.

Introduction: Pre-pectoral tissue expander (TE) placement has become an accepted breast reconstruction option, potentially minimizing chest-wall morbidity and perioperative pain. Comparative effectiveness studies examining complications and health related-quality of life (HR-QoL) however are lacking. This study aims to explore early, 90-day clinical and HR-QoL outcomes comparing pre-pectoral versus sub-pectoral TE breast reconstruction.
Methods: Propensity score matching analysis (nearest neighbor, 1:1 matching without replacement) was performed for pre-pectoral and sub-pectoral patients. Matched covariates included age, body mass index (BMI), race/ethnicity, smoking status, chemotherapy, radiotherapy, nipple-sparing mastectomy, axillary lymph-node dissection, and laterality of reconstruction. Outcomes of interest included complications and BREAST-Q physical well-being of the chest (PWBC) scores.
Results: 983 patients were evaluated, with 262 patients included in the final analysis. The matched cohort had no differences in baseline characteristics. There were no significant differences between cohorts in 90-day complications except for pre-pectoral patients having higher rates of breast seromas(p=0.002, Table 1.). PWBC scores did not differ significantly in the postoperative period overall, however subgroup analysis of bilateral patients demonstrated significantly higher scores at 6weeks in pre-pectoral patients(p<0.001).
Conclusion: In a matched analysis of early outcomes, pre-pectoral TE had higher seroma rates compared to sub-pectoral TE, though bilateral patients demonstrated improved patient reported recovery at 6 weeks. Continued long-term analysis of clinical and patient reported outcomes is warranted to understand the full profile of this technique.


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