Subpectoral versus prepectoral two-stage breast reconstruction: A propensity score-matched analysis of 30-day morbidity and long-term outcomes

Escandón, Joseph M.; Sweitzer, Keith; Christiano, Jose G.; Gooch, Jessica C.; Olzinski, Ann Therese; Prieto, Peter A.; Langstein, Howard N.; Manrique, Oscar J.

doi:10.1016/j.bjps.2022.10.028

Cited by 13 publications

(19 citation statements)

References 32 publications

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“…Apprehensions regarding the technical complexity, prolonged surgical time, surgical-site morbidity, poor reimbursement and prolonged recovery with free tissue transfer continue to represent obstacles to the wide adoption of autologous breast reconstruction. [35][36][37][38][39][40][41] Therefore, implant-based breast reconstruction remains the most common technique. [35][36][37][38][39][40][41] In this setting, current efforts from surgeon scientists and researchers have been focused on strategies to reinforce patient safety and improve the postoperative course of autologous breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37][38][39][40][41] Therefore, implant-based breast reconstruction remains the most common technique. [35][36][37][38][39][40][41] In this setting, current efforts from surgeon scientists and researchers have been focused on strategies to reinforce patient safety and improve the postoperative course of autologous breast reconstruction. [42][43][44] The incorporation of a co-surgeon to optimize operative time and reduce general anesthesia duration has been promoted as a versatile strategy for increasing effectiveness while reducing the rate of complications related to MBR.…”

Section: Discussionmentioning

confidence: 99%

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The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

Escandón,

Mascaro-Pankova,

DellaCroce

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Using a co-surgeon model has been suggested to improve perioperative outcomes and reduce the risk of complications. Therefore, we evaluated if a co-surgeon model compared with a single microsurgeon model could decrease the surgical time, length of stay, rate of complications, and healthcare-associated costs in adult patients undergoing microvascular breast reconstruction (MBR). A comprehensive search was performed across PubMed MEDLINE, Embase, and Web of Science. Studies evaluating the perioperative outcomes and complications of MBR using a single-surgeon model and co-surgeon model were included. A random-effects model was fitted to the data. Seven retrospective comparative studies were included. Ultimately, 1411 patients (48.23%) underwent MBR using a single-surgeon model, representing 2339 flaps (48.42%). On the other hand, 1514 patients (51.77%) underwent MBR using a co-surgeon model, representing 2492 flaps (51.58%). The surgical time was significantly reduced using a co-surgeon model in all studies compared with a single-surgeon model. The length of stay was reduced using a co-surgeon model compared with a single-surgeon model in all but one study. The log odds ratio (log-OR) of recipient site infection (log-OR = −0.227; P = 0.6509), wound disruption (log-OR = −0.012; P = 0.9735), hematoma (log-OR = 0.061; P = 0.8683), and seroma (log-OR = −0.742; P = 0.1106) did not significantly decrease with the incorporation of a co-surgeon compared with a single-surgeon model. Incorporating a co-surgeon model for MBR has minimal impact on the rates of surgical site complications compared with a single-surgeon model. However, a co-surgeon optimized efficacy and reduced the surgical time and length of stay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

Escandón,

Mascaro-Pankova,

DellaCroce

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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“…Gives patients time to adjust to the reconstructed breast and decide if they want additional procedures, such as nipple reconstruction or fat grafting. 45 Advantages of single-stage reconstruction include: 1. Requires fewer surgeries overall, which can be more convenient for patients; 2.…”

Section: Discussionmentioning

confidence: 99%

Advances in Prepectoral Breast Reconstruction

Xie¹,

Yan²,

Zhu³

et al. 2023

TCRM

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Breast reconstruction can be divided into prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR) according to the implant plane. The original prepectoral breast reconstruction was abandoned for a long time due to the frequent and severe complications. Now, advances in materials technology and improved methods of mastectomy have made safe prepectoral breast reconstruction possible. Moreover, a number of studies have gradually demonstrated the advantages of prepectoral breast reconstruction. As prepectoral breast reconstruction becomes more and more attractive, it is time to review the current advances in prepectoral breast reconstruction.

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“…Historically, prepectoral position was associated with higher complications including capsular contracture and implant exposure but with improvement in surgical techniques and use of ADM (currently off-label use), these complications are significantly reduced leading to regaining popularity of the prepectoral implant placement[ 18 ]. With subpectoral positioning of the implant, it is a common practice to create an ADM sling (currently off-label use) for the exposed part of the implant below the pectoralis major muscle (dual-plane or partial subpectoral)[ 19 ]. Subpectoral implant placement has outpaced the historically higher rate of capsular contracture with prepectoral implant placement and it is also associated with a higher rate of animation deformity[ 17 ].…”

Section: Implant-based Reconstructionmentioning

confidence: 99%

Breast reconstruction: Review of current autologous and implant-based techniques and long-term oncologic outcome

Malekpour¹,

Malekpour²,

Wang³

2023

World J Clin Cases

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Implant-based reconstruction is the most common method of breast reconstruction. Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding. The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options. Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

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Subpectoral versus prepectoral two-stage breast reconstruction: A propensity score-matched analysis of 30-day morbidity and long-term outcomes

Cited by 13 publications

References 32 publications

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

Advances in Prepectoral Breast Reconstruction

Breast reconstruction: Review of current autologous and implant-based techniques and long-term oncologic outcome

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