<p>Prepectoral Breast Reconstruction: An Overview of the History, Technique, and Reported Complications</p>

Abstract

Prepectoral breast reconstruction is an increasingly prevalent form of breast reconstruction. Prepectoral breast reconstruction was abandoned in the past due to various complications but has recently made a resurgence due to the development of acellular dermal matrices and innovative techniques. The purpose of this review article is to discuss the history, techniques, benefits, and potential complications of prepectoral breast reconstruction. The article also reviews current literature to evaluate published complication rates. Complications evaluated include infection (3.67%), wound dehiscence (2.10%), skin necrosis (3.67%), seroma (2.89%), hematoma (1.34%), implant loss (3.28%), return to the OR (6.15%), contracture (3.61%), and rippling (7.38%). In conclusion, prepectoral breast reconstruction is a reliable, safe, and aesthetically feasible method of breast reconstruction. With increasing interest in this technique, it is important that surgeons and patients are familiar with prepectoral reconstruction and this article aims at providing this information.

A comprehensive literature review of patient‐reported outcome measures (PROMs) among common breast reconstruction options: What types of breast reconstruction score well?

“…The prepectoral implant placement technique is becoming increasingly popular, with short‐term complications no different than in subpectoral placement 41,42 . While costs may be higher for prepectoral placement, advantages with this technique include a lack of animation deformity and possible decreased postoperative pain when compared to the subpectoral placement technique 43 . Therefore, it is logical that patients prefer prepectoral over subpectoral implant placement after mastectomy, as indicated by higher PROM scores.…”

Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion

“…The use of tabbed tissue expanders and acellular dermal matrix has been reported to reduce contracture rates and stabilize the expander within the pocket without excessive thickening of the soft tissue envelope 4,25–27 . In addition, the tissue expander is routinely underfilled relative to the implant to avoid redundant skin and rippling 28 . Technical pearls include the use of a “hand-in-glove” fit of the implant in the breast pocket to limit free subcutaneous space, implant motion within the pocket, and capsular contracture 8 .…”

“…4,[25][26][27] In addition, the tissue expander is routinely underfilled relative to the implant to avoid redundant skin and rippling. 28 Technical pearls include the use of a "hand-in-glove" fit of the implant in the breast pocket to limit free subcutaneous space, implant motion within the pocket, and capsular contracture. 8 Cohesive "form-stable" silicone implants offer improved shape and reduced rippling relative to older generations of less cohesive implants.…”

Meshed Acellular Dermal Matrix for Two-Staged Prepectoral Breast Reconstruction: An Institutional Experience

“…This technique dates back to the early use of implants in the 1960s but fell out of favor because of the increased rates of infection, excessive scar tissue formation causing capsular contracture, and occasional implant exposure. 1 These complications were attributed to inadequate soft tissue coverage. 2 Subsequently, surgeons placed the implants subpectorally, which provided more vascularized soft tissue coverage and addressed the aforementioned problems.…”

“… 3 4 Aesthetically, this technique resulted in decreased projection and definition of the breast. 1 The advent of acellular dermal matrices (ADMs) has led plastic surgeons to reexplore prepectoral prosthesis placement for breast reconstruction. ADM provides an additional layer of soft tissue support for the tissue expander or implant, and reduces capsular contracture by serving as a barrier to the host's foreign body immune response.…”