Comparing Prepectoral Versus Subpectoral Tissue Expander Placement Outcomes in Delayed-Immediate Autologous Breast Reconstruction

Abstract

Background Delayed-immediate breast reconstruction has traditionally involved placement of tissue expanders (TE) in the subpectoral (SP) position. Development of acellular dermal matrices has renewed interest in the prepectoral (PP) pocket, which avoids extensive muscle manipulation. We compare complication rates between PP and SP TE placement in autologous delayed-immediate breast reconstruction. Methods A retrospective chart review of patients undergoing autologous, delayed-immediate breast reconstruction at our institution (June 2009 to December 2018) was performed. Demographics, comorbidities, perioperative information, and complication incidence ≤12 months' follow-up were collected from first- and second-stage surgeries. Complications were modeled using univariable and multivariable binary logistic regressions. Results A total of 89 patients met the inclusion criteria, and data from 125 breast reconstructions were evaluated. Complication rates following TE placement trended lower in the PP cohort (28.8% vs 37%, P = 0.34). Overall complication rates following autologous reconstruction were significantly lower for PP reconstructions (7.7% vs 23.3%, P = 0.02). Multivariable regression showed TE position (P = 0.01) was a significant predictor of ≥1 complication following autologous reconstruction. Time delay between first- and second-stage surgeries was greater for SP reconstructions (199.7 vs 324.8 days, P < 0.001). Postoperative drains were removed earlier in the PP cohort (8.6 vs 12.0 days, P < 0.001). Mean follow-up time was 331.3 days. Conclusions Prepectoral reconstruction in the delayed-immediate autologous reconstruction patient leads to significantly lower complication rates, shorter duration between first- and second-stage surgeries, and shorter times before removal of breast drains compared with SP reconstructions.

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

“…A diagnosis of breast cancer and subsequent treatments are stressful events in a patient’s life, associated with an increased risk of anxiety, depression and psychosocial implications [ 34 ], [ 35 ], [ 36 ]. The decision to proceed with a mastectomy can lead to a feeling of loss of feminity, issues around sexuality and self-esteem as well as practical problems associated around clothing and the wearing of a prosthesis [ 34 ], [ 35 ].…”

“…This may be seen as an integral addition to their breast cancer treatment, resulting in improvements to their appearance and general well-being. The beneficial effects of breast reconstruction have been widely reported, and the vast majority of women is satisfied with the overall outcome, irrespective of the type of procedure undertaken [ 35 ], [ 36 ].…”

“…At most breast centres, the majority of reconstructions is performed immediately, in a joint procedure between the breast surgeon, who performs the mastectomy, and the plastic surgeon [ 15 ], [ 19 ], [ 31 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ]. Pre-operatively, this allows for mastectomy skin sparing incisions to be discussed between the two teams which can then be incorporated in the final decision on the optimal reconstruction to best suit the patient.…”

“…Delayed reconstruction is also an option for many patients who are overwhelmed with their recent diagnosis and respective surgical treatment [ 34 ], [ 35 ], [ 36 ]. lt gives them time to make a fully informed decision before choosing the type of reconstruction that would benefit them [ 34 ], [ 35 ], [ 36 ].…”

“…A third option of immediate-delayed reconstruction may provide an alternative solution for those patients awaiting histological confirmation and possible post-mastectomy radiotherapy [ 36 ]. In this situation, a saline tissue expander implant is placed at the time of mastectomy protecting the breast skin envelope and remains until the patient completes the radiation cycle [ 30 ], [ 32 ], [ 36 ]. They can then undergo the standard delayed reconstruction.…”