A Critical Appraisal of Late Complications of Prepectoral versus Subpectoral Breast Reconstruction Following Nipple-Sparing Mastectomy

King, Caroline A.; Bartholomew, Alex J.; Sosin, Michael; Avila, Azalia; Famiglietti, Amber; Dekker, Paige K.; Perez‐Alvarez, Idanis M.; Song, David H.; Fan, Kenneth L.; Tousimis, Eleni

doi:10.1245/s10434-021-10085-z

Cited by 25 publications

(22 citation statements)

References 31 publications

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“…Furthermore, the sub-pectoral cohort was found to have a greater incidence of fat grafting (8.4% vs 4.0%). Several other studies have reported higher rates of post-operative revision following sub-pectoral reconstruction, despite similar immediate complication safety profiles when compared to pre-pectoral reconstruction 23 , 42 . As revision procedure cost data was outside the scope of our study, it is difficult to ascertain the exact impact of the additional procedures on cost.…”

Section: Discussionmentioning

confidence: 89%

Cost analysis of pre-pectoral implant-based breast reconstruction

Chinta

Koh

Sobti

et al. 2022

Sci Rep

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With improvement in mastectomy skin flap viability and increasing recognition of animation deformity following sub-pectoral implant placement, there has been a transition toward pre-pectoral breast reconstruction. While studies have explored the cost effectiveness of implant-based breast reconstruction, few investigations have evaluated cost with respect to pre-pectoral versus sub-pectoral breast reconstruction. A retrospective review of 548 patients who underwent mastectomy and implant-based breast reconstruction was performed from 2017 to 2020. The demographic and surgical characteristics of the pre-pectoral and sub-pectoral cohorts were well matched, except for reconstructive staging, as patients who underwent pre-pectoral reconstruction were more likely to undergo single-stage instead of two-stage reconstruction. Comparison of institutional cost ratios by reconstructive technique revealed that the sub-pectoral approach was more costly (1.70 ± 0.44 vs 1.58 ± 0.31, p < 0.01). However, further stratification by laterality and reconstructive staging failed to demonstrate difference in cost by reconstructive technique. These results were confirmed by multivariable linear regression, which did not reveal reconstructive technique to be an independent variable for cost. This study suggests that pre-pectoral breast reconstruction is a cost-effective alternative to sub-pectoral breast reconstruction and may confer cost benefit, as it is more strongly associated with direct-to-implant breast reconstruction.

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Section: Discussionmentioning

confidence: 89%

Cost analysis of pre-pectoral implant-based breast reconstruction

Chinta

Koh

Sobti

et al. 2022

Sci Rep

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“…We excluded patients with rippling (two cases) and capsular contracture (four cases) from our analysis owing to the fact that longer follow-up is needed [18,19].…”

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confidence: 99%

A Retrospective Study Assessing the Outcomes of Immediate Prepectoral and Subpectoral Implant and Mesh-Based Breast Reconstruction

Wow

Kolacinska-Wow

Wichtowski

et al. 2022

Cancers

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(1) Introduction: In response to patient concerns about breast cancer recurrence, increased use of breast magnetic resonance imaging and genetic testing, and advancements in breast reconstruction techniques, mastectomy rates have been observed to rise over the last decade. The aim of the study is to compare the outcomes of prepectoral and subpectoral implants and long-term, dual-stage resorbable mesh-based breast reconstructions in mutation carriers (prophylactic surgery) and breast cancer patients. (2) Patients and methods: This retrospective, two-center study included 170 consecutive patients after 232 procedures: Prepectoral surgery was performed in 156 cases and subpectoral was performed in 76. (3) Results: Preoperative chemotherapy was associated with more frequent minor late complications (p < 0.001), but not major ones (p = 0.101), while postoperative chemotherapy was related to more frequent serious (p = 0.005) postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications (31.03%) than no-radiotherapy (12.21%; p < 0.001). Multivariate logistic regression found complications to be significantly associated with an expander (OR = 4.43), skin-reducing mastectomy (OR = 9.97), therapeutic mastectomy vs. risk-reducing mastectomy (OR = 4.08), and postoperative chemotherapy (OR = 12.89). Patients in whom prepectoral surgeries were performed demonstrated significantly shorter median hospitalization time (p < 0.001) and lower minor complication rates (5.77% vs. 26.32% p < 0.001), but similar major late complication rates (p = 0.915). (4) Conclusions: Implant-based breast reconstruction with the use of long-term, dual-stage resorbable, synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, prospective, multicenter, and long-term outcome data studies are needed to further evaluate the benefits of such treatments.

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“…This year, the OPBC voting results stressed the need for phase III RCTs to specifically address the optimal timing of implant-based BR, the positioning of implants and the use of adjunctive mesh. Of note, multiple observational studies over the past three years on pre-versus sub-pectoral implant-based BR have predominantly shown either no difference or marginally favoured pre-pectoral positioning [ [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. However, most were small, retrospective and single-centre studies, with only a few prospective or multicentre studies [ 25 , 26 , 28 ].…”

Section: Resultsmentioning

confidence: 99%