Go Pre or Stay Sub? Immediate implant-based breast reconstruction: A systematic review and meta-analysis

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Implant-based breast reconstruction is a common procedure.
• The placement of breast implants can be prepectoral or subpectoral.
• Patient selection and surgical technique influence outcomes.

Purpose of the Study:

• To compare postoperative complications between prepectoral and subpectoral implant-based breast reconstruction.
• To evaluate implant loss, dehiscence, seroma, infection, necrosis, and re-operation rates.
• To assess complication severity using the Clavien-Dindo classification system.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA guidelines.
• Literature search across PubMed, Embase, Cochrane Library, and ClinicalTrials.gov.
• Meta-analysis of implant loss and odds ratios for other complications.

Main Results:

• Eighteen studies met inclusion criteria from 1087 identified.
• No significant difference in implant loss between prepectoral (1045 cases) and subpectoral (1485 cases) groups (OR = 1.00, p > 0.99).
• No significant differences in complication severity or frequency (seroma, dehiscence, infection, necrosis, re-operation) between the two placements.

Conclusions:

• Prepectoral and subpectoral implant-based breast reconstruction demonstrate comparable outcomes regarding implant loss.
• Standardized assessment using the Clavien-Dindo system showed no significant differences in complication rates or severity.
• Prepectoral placement is a safe alternative to subpectoral placement in carefully selected patients.