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

Abstract

(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.

Mastectomy and Immediate Breast Reconstruction with Pre-Pectoral or Sub- Pectoral Implant: Assessing Clinical Practice, Post-Surgical Outcomes, Patient’s Satisfaction and Cost

“…Pre-pectoral implant-IBR significantly increase according to years of treatment (6.0% to 72.7%) similarly to results reported by King et al [ 37 ] (0% to 92.4%). Implant-IBR rate and type of mastectomy: pre-pectoral implant-IBR was performed less frequently for SSM than NSM, in Wow et al, study [ 36 ] (10.6% versus 81.6%, respectively) as we report (18.4% versus 45.9%). It is difficult to compared absolute complications rates between studies, due to a large disparity of IBR types, reported complications, indications for mastectomies, and monitoring time.…”

“…In contrast, we don’t report difference (2.76% versus 4.08%) like Momeni et al [ 40 ] (30% for pre-pectoral and 22.5% for sub-pectoral). We don’t observe difference of major complications rates between pre and sub-pectoral implant-IBR like others, 10.9% pre versus 9.21% sub pectoral [ 36 ]. However, Momeni et al [ 40 ] reported higher major complication rate for sub-pectoral procedure (22.5% versus 7.5%) without significant difference (p=0.060).…”

“…Significant higher prosthetic failure rate was reported for sub-pectoral versus pre-pectoral in King et al study [ 37 ] (18.7% versus 7.9%), but without significant difference in Momeni et al study [ 40 ] (2.5 versus 12.5% for pre and sub-pectoral implant IBR respectively), in meta-analysis reported by Chatterjee [ 39 ] and meta-analysis reported by Li et al [ 38 ], and without difference in the present study. A significant shorter median hospitalization time for pre-pectoral implant-IBR was reported by Wow et al [ 36 ], with a median time of 4 days for all patients. With a shorter median LPOS of 1 day, we don’t observe difference between pre and sub-pectoral implant-IBR.…”

“…Complication rates with pre-pectoral versus sub-pectoral implant-IBR were similar in meta-analysis reported by Li et al [ 38 ] and in meta-analysis reported by Chatterjee et al [ 39 ], but with lower odds of infection for pre-pectoral implant-IBR, and with higher rate of smokers, PMRT and diabetes in sub-pectoral procedures. Minor complications occurred more often for sub-pectoral procedures in Wow et al [ 36 ] study (26.32% versus 5.77%). In contrast, we don’t report difference (2.76% versus 4.08%) like Momeni et al [ 40 ] (30% for pre-pectoral and 22.5% for sub-pectoral).…”

“…In the UK multicenter prospective cohort study [ 21 ], 2108 patients had 2655 mastectomies with implant-IBR in 81 units during 28 months: 11 patients’ per-year per unit in comparison with 152 implant-IBR patient’s per-year in this study. Moreover, Wow et al [ 36 ] recently reported 232 implant-IBR with definitive implant or expander in two centers during 31 months (45 patients per-year per-center) including 123 risk-reducing mastectomy (53.0%) and a low rate of implant-IBR for BC (109 patients: 47%). In our study 85.8% of implant-IBR was performed for BC.…”