Prepectoral Breast Reconstruction: A Growth Story

Background: Direct-to-implant prepectoral breast reconstruction has recently experienced a resurgence in popularity because of its lower levels of postoperative pain and animation deformity. BREAST-Q, a well-validated patient-reported outcomes tool, was used to assess patient satisfaction and quality of life. The goal of this study was to assess patient-reported outcomes at 6-month and 1-year follow-up after direct-to-implant prepectoral breast reconstruction. Methods: Sixty-nine consented adult patients undergoing a total of 110 direct-to-implant, prepectoral, postmastectomy breast reconstructions completed BREAST-Q questionnaires immediately preoperatively, and at 6 and 12 months thereafter. Results: Mean breast satisfaction decreased nonsignificantly from 61.3 preoperatively to 58.6 at 12 months after reconstruction (p = 0.32). Psychosocial well-being improved nonsignificantly from 67.1 preoperatively to 71.1 at 12-month follow-up (p = 0.26). Physical well-being of the chest was insignificantly different, from 74.4 to 73.3 at 12-month follow-up (p = 0.62). Finally, sexual well-being similarly remained nonsignificantly changed from 60.2 preoperatively, to 59.1 at 12 months (p = 0.80). The use of acellular dermal matrix and postmastectomy radiotherapy did not have any significant effects on patient-reported outcomes. Through regression analysis, neoadjuvant chemotherapy, increased age, and incidence of rippling were found to negatively influence BREAST-Q results. Conclusions: Patients who underwent direct-to-implant prepectoral breast reconstruction demonstrated an overall satisfaction with their outcomes. As prepectoral breast reconstruction continues to advance and grow in popularity, patient-reported outcomes such as those presented in this study become of paramount importance in practice. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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“…Although not yet universally adopted by all breast plastic surgeons, recent data have demonstrated its rapid growth across many countries. 1…”

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confidence: 99%

Direct-to-Implant Prepectoral Breast Reconstruction: Patient-Reported Outcomes

Safran

Al-Halabi

Viezel-Mathieu

et al. 2021

Plastic &Amp; Reconstructive Surgery

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“…In light of these developments, plastic surgeons switched to placing the breast implant under the pectoralis muscle, which provides improved coverage of the implant and decreases the rates of capsular contracture. However, this so‐called subpectoral placement is not an anatomic position for a breast implant, can be more painful (at least initially), and cause an animation deformity, meaning that the pectoralis muscle lies directly under the mastectomy skin and can cause an unsightly appearance of the skin as the muscle contracts and the implant is displaced inferolaterally . In patients who undergo radiation, the pectoralis muscle fibrosis that occurs as a result causes more tightening over the implant and can sometimes result in limitation of shoulder abduction.…”

Section: Implant‐based Reconstructionmentioning

confidence: 99%

2020 special issue: Twenty years of breast reconstruction: Past, present, and future

2020

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Breast reconstruction has evolved in the last 25 years to provide women with better autologous and implant-based options. The general trends of breast reconstruction have shifted to skin and nipple-areolar complex preservation, resulting in improved aesthetics and patient satisfaction. Autologous reconstruction has made a dramatic How to cite this article: Spiegel A, Kania KL, Hamilton K. 2020 special issue: Twenty years of breast reconstruction: Past, present, and future. Breast J. 2020;26:39-41.

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“…Reconstructive and aesthetic breast implant surgery has experienced a notable increase in popularity over the past decade 1 , 2 ; each year, it is estimated that over 1.5 million breast implants are used for both reconstructive and aesthetic purposes, respectively. 3 , 4 However, up to 19% of patients with breast implants, and as high as 40% of implanted patients with a previous history of breast irradiation are estimated to develop capsular contracture.…”

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confidence: 99%

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

Abi‐Rafeh

Safran

Winocour

et al. 2022

Aesthetic Surgery Journal Open Forum

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Background Although plastic surgeons commonly perform capsulectomies for a variety of peri-prosthetic capsular conditions, the safety of capsulectomy remains unknown, and the literature lacks evidence describing its morbidity and complication rates for patients inquiring about its associated risks. Objectives The present study aims to identify and define the complication rates associated with capsulectomies. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between the years 2015-2018. All information pertaining to demographics, patient-related information, surgical indications, procedure-related information, outcomes, and complications, were assessed. Results The study identified 2231 cases of surgeon-reported capsulectomies; indications most commonly reported included capsular contracture (n=638, 28.6%) and breast implant rupture (n=403, 18.1%). 141 patients (6.32%) were hospitalized for longer than one post-operative day (range 2-28 days), while the overall complication rate was 3.0% (n=67/2231 patients). Incidence of minor complications, representing superficial surgical site infections, was 0.8%, while the major complication rate was 2.24%. These included 7 cases of deep surgical site infections (0.3%), 19 organ space infections (0.9%) and 8 cases of wound dehiscence (0.4%). Eight patients developed sepsis (0.4%); 6 patients required transfusions (0.3%), one case of post-operative pneumonia and one myocardial infarction were also identified (n=1 each, 0.0%). The overall reoperation and readmission rates were 2.0%, representing a readmission rate of 66% among patients with complications. Conclusions The present study provides the first estimate of the incidence of complications associated with capsulectomies. Although the NSQIP database contains significant limitations, the data presented herein describes a complication profile that plastic surgeons can share with their patients during informed consent.

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Prepectoral Breast Reconstruction: A Growth Story

Cited by 11 publications

References 3 publications

Direct-to-Implant Prepectoral Breast Reconstruction: Patient-Reported Outcomes

Direct-to-Implant Prepectoral Breast Reconstruction: Patient-Reported Outcomes

2020 special issue: Twenty years of breast reconstruction: Past, present, and future

Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

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