Subcutaneous Prosthetic Breast Reconstructions following Skin Reduction Mastectomy

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Surgery

Background:

• Prepectoral prosthetic breast reconstruction is increasingly popular for its muscle-sparing benefits.
• It offers comparable outcomes to subpectoral placement in smaller breasts.
• This study evaluates complications in large, ptotic breasts undergoing immediate reconstruction.

Purpose of the Study:

• To compare the complication rates of prepectoral versus subpectoral immediate prosthetic breast reconstruction.
• To analyze outcomes following Wise pattern skin reduction mastectomy in patients with large and ptotic breasts.

Main Methods:

• Retrospective review of patients undergoing immediate tissue expander reconstruction post-Wise pattern skin reduction mastectomy (Nov 2011-Aug 2017).
• Data collected included patient demographics and specific complications (necrosis, hematoma, infection, seroma, implant loss, capsular contracture).

Main Results:

• 45 subpectoral and 42 prepectoral reconstructions were analyzed.
• Subpectoral group had higher BMI, larger implant volumes, and significantly more skin necrosis and infections.
• Prepectoral group experienced more seromas, but overall complication rates were not significantly different between groups (62.2% vs. 40.5%).

Conclusions:

• Prepectoral tissue expander placement is an attractive option for large, ptotic breasts.
• Prosthetic reconstruction post-Wise pattern mastectomy has high complication rates regardless of implant plane.
• Enhanced patient counseling and complication prevention strategies are essential for this patient population.