K. P. Nealon1, R. E. Weitzman1, N. Sobti1, A. S. Colwell1, W. G. Austen1, E. C. Liao1 1Massachusetts General Hospital,Division Of Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction: Breast cancer is among the most common cancers diagnosed in women, affecting 1 in 8 women per year. Immediate implant-based breast reconstruction is the leading technique for post-mastectomy reconstruction, trending toward direct to implant (DTI) as the preferred method when compared to the traditional tissue expander method. Although implants are generally placed beneath the pectoralis major muscle, recent developments have allowed for implant placement above the muscle in a pre-pectoral plane. This study compares the safety endpoints and risk factors in prepectoral vs. subpectoral DTI breast reconstruction cohorts. We hypothesize that prepectoral DTI breast reconstruction is a safe alternative to subpectoral DTI breast reconstruction.
Methods: Retrospective chart review at a tertiary academic medical institution identified 107 patients who underwent prepectoral DTI reconstruction and 158 patients who underwent subpectoral DTI reconstruction. Univariate analysis was performed to compare patient characteristics between both cohorts. A penalized logistic regression identified relationships between postoperative complications and covariate variables in each group.
Results: A binomial regression model revealed that prepectoral DTI breast reconstruction is associated with lower risk of surgical site infection (p = 0.011) and lower risk of revision (p = 0.015) when compared to subpectoral DTI breast reconstruction. Prepectoral DTI breast reconstruction is also associated with lower risk of capsular contracture, trending towards significance (p = 0.064). Rates of overall complication, explant, skin necrosis and hematoma were comparable between groups.
Conclusion: This study compares the safety outcomes and risk factors in prepectoral versus subpectoral DTI breast reconstruction cases. Prepectoral DTI breast reconstruction is associated with lower rates of surgical site infection, revision, and capsular contracture. It is speculated that the significant difference in surgical site infection may be due to decreased procedure time of the prepectoral procedure, or less dissection and devascularization of the soft tissue surrounding the implant. Fewer overall complications in the prepectoral group also resulted in a decreased number of revisions. Due to lack of manipulation of the pectoralis major muscle, prepectoral implant placement reported decreased rates of capsular contracture. These results demonstrate that prepectoral DTI reconstruction is a safe alternative when compared to subpectoral DTI reconstruction.
