Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Systemic Review and Meta-analysis

Abstract

Background Implant-based breast reconstruction (IBBR) remains the standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR. Methods A systematic search of PubMed and Cochrane Library from January 1, 2011 to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines, data were extracted by independent reviewers. Studies that compared prepectoral with subpectoral IBBR for breast cancer were included. Results Overall, 15 studies with 3,101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contractures (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32–0.92; P = 0.02), animation deformity (OR, 0.02; 95% CI, 0.00–0.25; P = 0.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42–0.80; P = 0.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64–1.09; P = 0.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P = 0.60), hematoma (OR, 0.76; 95% CI, 0.49–1.18; P = 0.22), infection (OR, 0.87; 95% CI, 0.63–1.20; P = 0.39), skin flap necrosis (OR, 0.70; 95% CI, 0.45–1.08; P = 0.11), and recurrence (OR, 1.31; 95% CI, 0.52–3.39; P = 0.55). Similarly, no significant difference was found in Breast-Q scores between the prepectoral and subpectoral IBBR groups. Conclusions The results of our systematic review and meta-analysis demonstrated that prepectoral, implant-based, breast reconstruction is a safe modality and has similar outcomes with significantly lower rates of capsular contracture, prosthesis failure, and animation deformity compared with subpectoral, implant-based, breast reconstruction.

Ptotic versus Nonptotic Breasts in Nipple-sparing Mastectomy and Immediate Prepectoral Breast Reconstruction

“…However, the mean number of complication was significantly higher in subpectoral IBBR. [14][15][16][17][18] The use of acellular dermal matrices (ADMs) and synthetic meshes in IBBR is becoming more preferable every day, especially with promising opportunities for prepectoral single-stage placement. Early reports showed several benefits, including less skin flap necrosis and capsular contracture, less need for tissue expander, superior aesthetic results, and lower rates.…”

Solutions in Breast Reconstruction

“…However, recent studies indicate that prepectoral pocket selection is similar to submuscular pocket selection in terms of complication rates. In a study by Ostapenko et al, prepectoral placement was demonstrated to be superior to subpectoral in complications such as capsule contracture, implant loss, and animation deformity, while complication rates such as infection, hematoma, and seroma were similar in prepectoral and subpectoral breast reconstructions [60]. According to another study by Bekisz et al, no significant difference was detected in the rates of complications such as skin flap necrosis, minor infection requiring antibiotics, hematoma, and the need for implant replacement in terms of prepectoral, dual plan, and total submuscular pocket choices [61].…”

Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023

“…For implant-based reconstruction, pre- and subpectoral implant placement with or without additional devices (either synthetic or autologous like acellular dermal matrices) can be performed. Retrospective data of a current meta-analysis favored prepectoral placement [58], but data from the OPBC prospective study should be awaited for a clear recommendation [59]. Perioperative systemic antibiotic prophylaxis for implant-based reconstruction is recommended to be performed no longer than 24 h (LoE 2a/B/AGO+), and topical antibiotics/antiseptics should be used frequently as surgical site infection can be decreased significantly when compared to no topical antibiotics (LoE2a/B/AGO+); moreover, it reduces the rate of capsular contraction [60].…”