Two-Stage Prosthetic Breast Reconstruction: A Comparison Between Prepectoral and Partial Subpectoral Techniques

Area of Science:

• Plastic Surgery
• Oncology
• Reconstructive Surgery

Background:

• Prepectoral prosthetic breast reconstruction may offer advantages over subpectoral placement.
• This study compares clinical outcomes of two-stage reconstruction using prepectoral versus partial subpectoral tissue expander and implant placement.

Purpose of the Study:

• To assess and compare clinical outcomes following two-stage prosthetic breast reconstruction.
• Evaluate the safety and efficacy of prepectoral versus partial subpectoral implant placement.

Main Methods:

• Retrospective review of 39 prepectoral and 50 partial subpectoral patients.
• Acellular dermal matrix used in all cases; mean follow-up 8.7 (prepectoral) and 13 months (subpectoral).
• Patient demographics included age (mean 50.4/49.2 years), BMI > 30 (15.4%/18%), and radiation therapy (38.5%/22%).

Main Results:

• Overall adverse event rates were similar: 20.5% (prepectoral) vs. 22% (subpectoral).
• Surgical-site infection and seroma rates were comparable; explantation rates were 6.5% (prepectoral) and 7.2% (subpectoral).
• No explantation occurred in patients who received radiation or had BMI > 30. Four patients required conversion from subpectoral to prepectoral due to animation deformity.

Conclusions:

• Prepectoral breast reconstruction is a viable alternative to partial subpectoral reconstruction.
• Patient selection is crucial for successful outcomes.
• Prepectoral reconstruction is safe for patients with BMI < 40 and those undergoing postmastectomy radiation therapy.