Two-stage prepectoral breast reconstruction: A comprehensive review and meta-analysis

Implant-based breast reconstruction is the most used approach for breast reconstruction following mastectomy. Prosthetic breast reconstruction helps achieve optimal results with reduced operation time, offering advantages over direct-to-implant and subpectoral reconstruction in selected patients. This study aimed to provide a comprehensive overview of the two-stage prepectoral breast reconstruction.

A systematic literature search was performed, and the search was conducted across the PubMed, Cochrane, and Embase databases by adhering to the preferred reporting items for systematic reviews and meta-analysis guidelines. The inclusion criteria encompassed clinical trials or randomized clinical trials related to completed two-stage prepectoral breast reconstruction. Statistical analyses were conducted to synthesize the data and evaluate outcomes.

A total of 48 articles were included for analysis, evaluating 4461 patients and 3894 breasts. The most commonly performed mastectomy type was skin-sparing mastectomy, followed by nipple-areola complex-sparing mastectomy. For the first surgical step, the mean tissue expander size was 423.64 cc, with a mean final expander fill of 349.10 cc. The mean time between the first and second surgery stages was 6.21 months, and the mean follow-up time was 17.10 months. A total of 21.27% of the patients experienced at least one complication. Specifically, seroma was identified in 11.19%, infection in 8.97%, skin flap necrosis in 8.48%, capsular contracture in 6.74%, rippling/wrinkling in 11.30%, expander or implant exposure in 2.38%, and implant removal in 8.62% of the patients.

Two-stage prepectoral breast reconstruction is a viable surgical option for selected patients. The most frequent complication was seroma. Adjuvant radiotherapy was associated with a higher rate of infection and implant removal.