Complication Profile of Total Submuscular Versus Prepectoral Tissue Expander Placement

Abstract

BackgroundWe sought to compare the safety profile of prepectoral breast reconstruction with total submuscular tissue expander reconstruction, previously our standard. Primary outcomes of interest in this retrospective cohort study were incidence of infection, hematoma, seroma, mastectomy flap necrosis, and reconstruction loss.MethodsTotal submuscular and prepectoral with acellular dermal matrix reconstructions consecutively performed by a single surgeon (P.D.S.) between January 1, 2016, and December 31, 2019, were compared. Demographic and clinical characteristics, as well as complications and complication types, were extracted for all patients. A t test was used to assess differences in continuous variables. Multivariate logistics regression was used to assess the association between type of reconstruction and complication rate. The statistical significance was set at 0.05 for all comparisons.ResultsA total of 133 patients (234 breasts) were included. There was a significantly greater incidence of infection (16.5% vs 5.5%, P < 0.01) in the prepectoral/acellular dermal matrix cohort. However, reconstructive loss was low in both cohorts (2.5% and 3.0%, P = 0.83). Adjusted odds ratio for complications in the prepectoral cohort was 2.26, but this was not statistically significant (adjusted P = 0.24).ConclusionsPrepectoral breast reconstruction shares an overall complication profile that is not greater than that of total submuscular reconstruction. It is associated with a greater risk of infection; however, the ability to salvage the reconstruction with early, aggressive intervention results in low rates of reconstructive loss, comparable with those of total submuscular reconstruction.

Prepectoral vs. Submuscular Implant-based Breast Reconstruction: A Matched-Pair Comparison of Outcomes

“…Although their study did not find as high a rate of explantation, this is possibly attributable to their prepectoral cohort having a shorter average follow-up time. 28 Similar to a study by Plachinski et al, 30 our study found an increased risk of seroma formation in patients with prepectoral reconstruction as compared with submuscular reconstructions, and at a similar rate of roughly 20%. A recent article by Bekisz et al 33 also found that patients with prepectoral reconstruction experienced higher rates of seroma and explantation compared with patients with total submuscular reconstruction; the current study builds upon this understanding by using a larger cohort and matched populations.…”

“…32 The complication profile of prepectoral reconstructions agrees with some existing literature. Soni et al 28 similarly found a greater rate of SSIs in prepectoral reconstructions compared with total submuscular reconstructions. Although their study did not find as high a rate of explantation, this is possibly attributable to their prepectoral cohort having a shorter average follow-up time.…”

“…12,19 Furthermore, evidence is mixed in terms of differences in complications between prepectoral and subpectoral reconstructions. [28][29][30][31] The primary purpose of this study was to determine the clinical outcome profile of prepectoral versus submuscular implants at our academic, National Cancer Institute comprehensive cancer center-associated institution. We also sought to characterize infections of implant-based reconstructions, management of these infections, and the type and success of secondary reconstructions after primary failure.…”

“…12,19 Furthermore, evidence is mixed in terms of differences in complications between prepectoral and subpectoral reconstructions. 28–31…”