Evaluating Postoperative Narcotic Use in Prepectoral Versus Dual-plane Breast Reconstruction Following Mastectomy

Abstract

Background:The majority of postmastectomy breast reconstruction performed in the United States is device-based. Typically, a tissue expander or implant is placed in the dual-plane (ie, subpectoral). Prepectoral breast reconstruction with acellular dermal matrices following mastectomy is a relatively new technique that has favorable outcomes with minimal complications and satisfactory aesthetic results. Few studies have compared opioid use between the 2 approaches. This study compares duration of postoperative opioid use among patients undergoing prepectoral device-based breast reconstruction with those in whom dual-plane devices were placed.Methods:We reviewed the records of adult female patients aged 18 years or older who underwent prepectoral or dual-plane device-based breast reconstructions following mastectomy by one of the 2 plastic surgeons (A.M. or M.V.) from 2015 to 2017 at a large tertiary care hospital. Patients with a history of substance abuse, chronic pain, or who were already receiving opioid medication were excluded. Electronic medical records were reviewed and patient surveys were conducted during postoperative visits to determine postoperative opioid requirements.Results:During the study period, 58 patients underwent dual-plane breast reconstruction and 94 underwent prepectoral reconstruction. Demographics and comorbidities of the groups were similar. By multivariate regression analysis, the prepectoral reconstruction group required 33% fewer days on opioid analgesic medication (P = 0.016) and were 66% less likely to require opioid prescription refills (P = 0.027). There were no statistically significant differences in other outcomes or complications.Conclusion:Patients undergoing prepectoral tissue expander or implant-based reconstruction required fewer days of opioid pain medication than those managed with the dual-plane technique.

Comparison of Outcomes Following Prepectoral and Subpectoral Implants for Breast Reconstruction: Systematic Review and Meta-Analysis

“…Yet, previous studies have indicated that the incidence of pain after cancer surgery is significantly higher when breast reconstruction is performed, especially following the SP approach, with 49% of patients experiencing upper body acute and chronic pain syndrome [ 23 , 24 ]. Plachinski et al [ 21 ] found similar results, with no significant difference in pain scores between the two cohorts and that the evaluation of pain should be more inclusive of other intrinsic criteria such as chronic pain, comorbidities, age, and BMI, in opposition to most of the previous studies [ 15 , 25 , 26 ]. Lee et al [ 20 ] observed a significant difference in favor of the PP group when pain was assessed during shoulder motion two weeks postoperatively, and, interestingly, the scores of shoulder disability were significantly higher in the SP group.…”

Chronic Pain Following Cosmetic Breast Surgery: A Comprehensive Review

“…Overall, it was found that patients undergoing prepectoral reconstruction used opioids of 33% fewer days than those who underwent dual-plane reconstruction, suggesting that this surgical approach may be associated with reduced chronic postoperative pain. However, this study was limited by the lack of data on nonopioid medication consumed by patients [25]. In another study of 2207 women undergoing breast reconstruction, patients with deep inferior epigastric perforator (DIEP) flaps or superficial inferior epigastric (SIEA) perforator flaps had less pain 1 week postoperatively compared to tissue expanders/implant reconstruction on the McGill Pain Questionnaire-Sensory scale (p \ 0.01, p = 0.02).…”

Pectoral placement of tissue expanders affects inpatient opioid use

“…While other studies have shown reductions in postoperative opioid use in patients receiving prepectoral TEs, 23 to the best of our knowledge, this is the largest study to demonstrate a decrease in acute, inpatient opioid use following immediate prepectoral tissue expander placement. Prepectoral patients required on average 22 OME less than their subpectoral counterparts—the equivalent of nearly 15 mg of oral oxycodone.…”