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

The aim of this study was to compare postoperative complications between pre- and subpectoral implant-based breast reconstruction in non-irradiated patients.

This systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Literature search was performed using the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Meta-analysis assessed implant loss, while odds ratios (OR) were used to compare other postoperative complications, such as dehiscence, seroma, infection, necrosis, and re-operation. The Clavien-Dindo system was applied to standardize the comparison of complication severity.

The literature search identified 1087 studies. Eighteen met the inclusion criteria. A meta-analysis of 11 studies showed no significant difference in implant loss between the pre- (1045 cases) and subpectoral (1485 cases) groups (OR = 1.00, p > 0.99). Furthermore, the application of the Clavien-Dindo classification of postoperative complications revealed no significant differences in the severity or frequency of complications between the 2 implant placements. No significant differences were found for other postoperative outcomes including seroma, dehiscence, hematoma, infection, necrosis, and re-operation.

Pre- and subpectoral implant-based breast reconstruction have comparable outcomes for implant loss. There were no significant differences in the severity or frequency of complications when standardized using the Clavien-Dindo classification system. These findings suggest that prepectoral placement is as safe as subpectoral placement in appropriately selected patients. Future studies should focus on standardizing the reporting of complications to enhance comparability between sub- and prepectoral implant placement across studies, thereby improving surgical decision-making.