Practice patterns in prepectoral implant-based breast reconstruction: A survey of UK plastic surgeons

Prepectoral prosthetic breast reconstruction following mastectomy is an increasingly adopted alternative to the subpectoral. Despite its growing use, contemporary UK data specifically examining pre-pectoral practice among plastic surgeons remains limited. Variation also exists in surgical technique, acellular dermal matrix (ADM) use and clinical decision-making.

A national cross-sectional online survey was distributed to UK consultant plastic surgeons performing breast reconstruction within the NHS. The survey captured geographical distribution, annual reconstruction volumes, frequency of prepectoral implant use, ADM preferences, implant coverage technique and factors influencing clinical decision-making. Descriptive statistics, Friedman's test and pairwise Wilcoxon signed-rank tests with Bonferroni adjustment were employed for statistical analysis.

Twenty UK plastic surgeons responded. Of these, 80% (n = 16) reported performing pre-pectoral reconstruction. Among all respondents, 75% (n = 15) reported using the pre-pectoral plane in at least 50.0% of their implant-based reconstructions. Soft tissue coverage was rated the most important factor influencing plane selection, and was ranked significantly higher than smoking status (p = 0.01). Porcine ADM was used by 14 of 16 respondents (87.5%), and ADM availability was the only factor reaching significance on pairwise testing for product selection (p = 0.022). Complete anterior-posterior implant coverage was used by 10 of 16 surgeons (62.5%). Free-text responses suggested a perceived reduction in implant-based reconstruction within plastic surgery practice, with increasing involvement of breast and oncoplastic surgeons.

This survey identified variation in pre-pectoral implant-based breast reconstruction practice among responding UK consultant plastic surgeons, particularly in relation to ADM selection and implant coverage technique. Porcine ADM predominated, and local availability appeared to influence product selection. Free-text responses raised relevant questions regarding changing patterns of service delivery, trainee exposure and outcome monitoring in implant-based breast reconstruction.