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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
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Early Complications in Prepectoral Tissue Expander-Based Breast Reconstruction
Robyn N Rubenstein1, Minji Kim1, Ethan L Plotsker1
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Annals of Surgical Oncology
|January 20, 2024
Summary
Prepectoral breast reconstruction using tissue expanders (TEs) is safe, but higher mastectomy weight increases TE loss risk. Further research on soft tissue and patient outcomes is recommended.
Area of Science:
- Plastic Surgery
- Breast Reconstruction
- Surgical Complications
Background:
- Prepectoral implant placement for postmastectomy breast reconstruction is increasingly common.
- Potential benefits include reduced animation deformities and pain.
- The complication profile, particularly factors influencing tissue expander (TE) loss, requires further investigation.
Purpose of the Study:
- To examine the complication profile of prepectoral tissue expanders (TEs) in breast reconstruction.
- To identify specific factors associated with TE loss in this patient population.
Main Methods:
- Retrospective review of 1225 patients undergoing immediate prepectoral TE reconstruction (January 2018 - June 2021).
- Evaluation of patient demographics, comorbidities, and operative details.
- Logistic regression analysis to determine factors linked to TE loss.
Main Results:
- The most frequent complications were seroma (8.7%), infection/cellulitis (8.2%), and TE loss (4.2%).
- Univariate analysis identified ethnicity, smoking history, BMI, mastectomy weight, and neoadjuvant chemotherapy as potential factors for TE loss.
- Multivariate analysis revealed mastectomy weight as the only significant factor positively associated with TE loss (OR, 1.001; p=0.016).
Conclusions:
- Prepectoral two-stage breast reconstruction demonstrates a safe and acceptable early complication profile.
- Increasing mastectomy weight is identified as the primary risk factor for TE loss.
- Future research should focus on soft tissue envelope quality and patient-reported outcomes.
