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Prepectoral versus Subpectoral Implant-Based Breast Reconstruction: Evaluating the Shift
Holly Cordray1, Salman Khan1, Malia Voytik2
1From the Perelman School of Medicine at the University of Pennsylvania.
Plastic and Reconstructive Surgery
|October 6, 2025
Summary
The shift to prepectoral implants in breast reconstruction saw a rise in complications like infection and reoperation, despite benefits like reduced pain. Further research is needed to optimize prepectoral outcomes.
Area of Science:
- Plastic Surgery
- Breast Reconstruction
- Surgical Outcomes
Background:
- Implant-based breast reconstruction trends are evolving.
- A shift towards prepectoral implants over subpectoral implants is anticipated.
- This study correlates these shifts with clinical outcomes.
Purpose of the Study:
- To evaluate trends in implant-based breast reconstruction planes.
- To compare clinical outcomes between prepectoral and subpectoral implant placement.
- To identify potential risks and benefits associated with the shift in implant placement.
Main Methods:
- Retrospective cohort study of adult patients undergoing implant-based breast reconstruction (2018-2024).
- Linear regression used to analyze trends in implant plane selection over time.
- Chi-square/Fisher's tests and relative risk (RR) calculated to compare postoperative complications.
Main Results:
- Prepectoral reconstructions increased significantly from 4.0% in 2018 to 90.2% in 2024.
- Prepectoral placement showed lower rates of fat necrosis, nipple-areolar complex necrosis, and chronic pain.
- However, prepectoral reconstructions had higher rates of infection, delayed healing, readmission, reoperation for complications, and prosthetic failure.
Conclusions:
- A significant reversal in implant plane preference from subpectoral to prepectoral occurred between 2018-2024.
- Prepectoral reconstruction presents a doubled risk of readmission and reoperation, including a threefold risk of prosthetic loss.
- Further investigation is recommended to improve prepectoral reconstruction outcomes or reconsider subpectoral placement for high-risk patients.
