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American Association of Plastic Surgeons

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Deformity After Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Clinical Outcomes And Differential Costs Analysis
Pooja S. Yesantharao, MS, Franca Kraenzlin, MD, Sarah Persing, MD, MPH, Justin Sacks, MD, MBA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE: Though prepectoral implant-based breast reconstruction has regained popularity, it carries certain disadvantages such as contour deformity and rippling. This study evaluated deformity and revision surgery after prepectoral versus subpectoral breast reconstruction in post-mastectomy patients.
METHODS: This was a retrospective analysis of mastectomy patients undergoing implant-based reconstruction between October 2016-July 2019. Medical records were reviewed for patientsí clinical/demographic characteristics, surgeries, outcomes/revisions, and surgical charges.
RESULTS: One-hundred-eighty patients (296 breasts) met inclusion criteria. Median follow-up was 212 days for prepectoral and 203 days for subpectoral implants. After adjusting for clinical/demographic factors, a significantly-greater proportion of prepectoral implants developed skin rippling/wrinkling (46.5% versus 10.4%, p<0.0001) and superior pole contour deformity (59.4% versus 38.0%, p=0.02). However, adjusted capsular contracture rates were similar between prepectoral and subpectoral implants. A significantly-greater proportion of patients with prepectoral implants received fat grafting upon initial implant placement (75.4% versus 37.8%, p<0.0001) as well as revision fat grafting (78.3% versus 42.17%, p=0.03). Total revision surgery costs were greater in patients with prepectoral implants than subpectoral, though this difference reached borderline significance ($3154 versus $1636 respectively, p=0.05). Lastly, upon multivariate hierarchical regression of individual breasts, lower body mass index independently predicted prepectoral implant contour deformity/rippling.
CONCLUSIONS: Prepectoral implants were associated with greater postoperative rippling/contour deformity and revision costs than subpectoral implants. Such information could help inform decision-making regarding breast reconstruction, when weighed against previous data demonstrating improved quality of life/decreased pain and narcotic-use following prepectoral placement. Further study is required to comprehensively evaluate cost-effectiveness of prepectoral versus subpectoral implant-based reconstruction.


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