One-Year Outcomes in Prepectoral versus Subpectoral Alloplastic Breast Reconstruction

Prepectoral and subpectoral approaches to implant-based breast reconstruction (IBBR) are both reliable options after mastectomy. In this study, the authors compared 1-year complication rates, additional or revision procedures, and patient-reported outcomes between 2-stage prepectoral or subpectoral IBBR through propensity matching.

Female patients who underwent prepectoral or subpectoral 2-stage IBBR from January of 2017 to June of 2022 with BREAST-Q scores available 1 year after exchange were reviewed. Complication rates, additional or revision procedures at the time of exchange and within 1 year of exchange, and BREAST-Q scores preoperatively and at 1 year were compared between patient groups. Propensity score-matched analyses were used to reduce possible confounding or selection bias related to nonrandomized treatment assignment of patients.

Of 1732 overall patients, 878 patients were included in the matched analysis (439 in each cohort). Patients with prepectoral IBBR had significantly higher rates of implant-related cellulitis or infection (5.5% versus 1.8%; P = 0.008) and implant exposure (2.3% versus 0.2%; P = 0.016) compared with patients with subpectoral IBBR, and more commonly had fat grafting at the time of the exchange procedure. On BREAST-Q, Physical Well-Being of the Chest at 1 year was significantly higher in the patients with prepectoral IBBR (median, 80 [interquartile range, 64, 92] versus 76 [64, 85]; P < 0.001). No other differences in BREAST-Q outcomes were observed.

In this powered analysis comparing prepectoral and subpectoral implant reconstruction at 1 year, the authors found that patients with prepectoral IBBR experienced higher rates of complications, such as infection or implant exposure, after implant exchange but had improved health-related quality of life as defined by the BREAST-Q Physical Well-Being of the Chest domain.

Therapeutic, III.