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Surgical And Patient-reported Outcomes Of 694 Two-stage Prepectoral Vs. Subpectoral Breast Reconstructions
Malke Asaad, MD1, Jessie Z. Yu, MD1, Jackie Tran, MD2, Abbas Hassan, MD1, Jun Liu, PhD1, Brittney O'Grady, PA1, Charles Butler, MD1, Mark Clemens, MD1, Rene Largo, MD1, Alexander Mericli, MD1, Mark Schaverien, MB ChB, MD, MSc, Med1, John Shuck, MD1, Melissa Mitchell, MD1, Jesse C. Selber, MD, MPH1.
1MD Anderson Cancer Center, Houston, TX, USA, 2The University of Texas Medical Branch, Galveston, TX, USA.

PURPOSE: The purpose of this study is to assess the differences in complication rates and patient satisfaction between patients who underwent prepectoral and subpectoral implant-based breast reconstruction (IBR).
METHODS: We conducted a retrospective cohort study of patients who underwent two-stage IBR at our institution in 2018-2019. The study cohort was divided into those who received prepectoral and subpectoral tissue expander (TE). Surgical and patient-reported outcomes were compared between the groups.
RESULTS: A total of 694 reconstructions in 481 patients were identified (77% prepectoral, 17% subpectoral). The mean BMI was higher in the prepectoral group (27 vs. 25 kg/m2, p=0.001) while age and other comorbidities were similar between the two study cohorts. Patients in the prepectoral group were less likely to undergo postoperative radiotherapy (p=0.001). The overall complication rate was very similar at 29.3% in the prepectoral and 28.9% in the subpectoral group (p=0.887). Individual complications were also similar between the two groups. Device explantation occurred in 11.3% vs. 14% (p=0.436) of prepectoral vs. subpectoral IBRs, respectively. On multiple frailty model, device location was not associated with overall complications, infection, major complications, or device explantation. Mean satisfaction with the breast, psychosocial well-being, and sexual well-being were similar between the two groups. Median time to permanent implant exchange was significantly longer in the subpectoral group (200 vs. 150 days, p<0.001).
CONCLUSION: Prepectoral breast reconstruction results in similar surgical outcomes and patient satisfaction compared to patients undergoing subpectoral IBR.


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