Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women

Manrique, Oscar J.; Banuelos, Joseph; Abu‐Ghname, Amjed; Nguyen, Minh Doan T.; Tran, Nho V.; Martinez‐Jorge, Jorys; Harless, Christin A.; Sharaf, Basel; Jakub, James W.; Degnim, Amy C.; Boughey, Judy C.; Jacobson, Steven R.

doi:10.1097/gox.0000000000002119

Cited by 54 publications

(50 citation statements)

References 48 publications

(40 reference statements)

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“…However, there is a paucity of literature offering a direct comparison between the prepectoral approach to the more traditional dual plane approach in the setting of immediate reconstruction. The only study to offer such a comparison was published by Manrique et al 23 . which demonstrated comparable outcomes between both techniques in women younger than 40 years.…”

Section: Introductionmentioning

confidence: 99%

Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction

Quah

Graham

et al. 2021

ANZ Journal of Surgery

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Background Implant‐based reconstruction accounts for the majority of breast reconstructive procedures performed in Australia. More recently, immediate prepectoral implant reconstruction using the TiLOOP Bra Pocket has gained popularity. This study compares post‐surgical complications and patient‐reported quality of life outcomes between immediate prepectoral and dual plane implant reconstruction. Methods A retrospective study of 80 consecutive patients who underwent nipple‐sparing mastectomies and immediate implant reconstruction was conducted. Implants were either completely covered with TiLOOP Bra and/or TiLOOP Bra Pocket (pfm medical, Cologne, Germany) and secured in the prepectoral space (prepectoral group) or placed in the subpectoral plane with inferolateral mesh coverage (dual plane group). Data surrounding patient demographics, clinical details and post‐surgical outcomes were compared. Patient‐related quality of life outcomes were assessed with the Breast‐Q questionnaire. Results A total of 80 patients (109 breasts) operated on between June 2016 and December 2018 were included. The prepectoral and dual plane groups comprised of 40 patients each, including 50 and 59 operated breasts, respectively. Post‐operative complications were comparable with 11 (22%) overall complications in the prepectoral group and eight (14%) in the dual plane group (P = 0.313). Implant loss was uncommon with four (8%) cases in the prepectoral group and five (8.5%) in the dual plane group (P = 0.929). Patient‐reported quality of life outcomes were superior after prepectoral reconstruction with patients reporting a significantly higher score in the satisfaction with breasts domain (68.9 versus 57.5; P = 0.036). Conclusion Immediate prepectoral implant reconstruction with the TiLOOP Bra Pocket was associated with improved patient satisfaction and demonstrated no difference in early post‐operative outcomes.

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Section: Introductionmentioning

confidence: 99%

Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction

Quah

Graham

et al. 2021

ANZ Journal of Surgery

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“…1–5 The Goldilocks procedure represents an option for breast reconstruction for those patients who do not want to go flat or undergo complex, multistage breast reconstruction. 2–4,6–8…”

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confidence: 99%

Immediate Breast Reconstruction Using the Goldilocks Procedure: A Balance between More Surgery and Patient Satisfaction

Manrique

Kuruoglu

Yan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Since its first description in 2012, the Goldilocks procedure has become an option for immediate breast reconstruction, particularly for obese patients who are poor candidates for traditional implant or autologous reconstruction. In this work, the authors performed a longitudinal study of patients who underwent mastectomy with Goldilocks reconstruction to assess the incidence of additional surgical procedures, and to assess surgical outcomes and patient satisfaction. Methods: A retrospective review of patients who underwent mastectomy with the Goldilocks procedure only at Mayo Clinic Rochester between January of 2012 and September of 2019 was performed. Demographics, complications, additional breast procedures performed to attain the final results, and patient-reported outcomes using the BREAST-Q were recorded. Univariate and multivariable analyses were performed to identify statistical associations and risk factors. Results: Sixty-three patients (108 breasts) were included. Mean age was 57.8 years. Mean body mass index was 37.6 kg/m2. Median follow-up time after the mastectomy with the Goldilocks procedure was 15 months. The major complication rate within the first 30 days was 9.3 percent. Forty-four breasts (40.7 percent) underwent additional surgery. Dyslipidemia was significantly associated with an increased risk of additional surgery (adjusted hazard ratio, 2.00; p = 0.045). Scores in the four BREAST-Q domains were not statistically different between patients who had additional procedures and those who did not. Conclusions: Based on the results, the authors recommend a thorough preoperative discussion with patients who are candidates for the Goldilocks procedure to explore all options for reconstruction and their expectations, because it is crucial to reduce the necessity for additional operations in this high-risk population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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“…Although many articles are reporting close to zero failure rate, others are reporting significant rates of complications. 5 , 27 – 30 Overall, 40.4% of respondents reported being “very” or “extremely” concerned about the possibility for wound healing complications in their prepectoral reconstruction cases. Open response data from the survey similarly echoed these concerns, with providers citing mastectomy flap necrosis, seroma, and infection as barriers to using this technique.…”

Section: Discussionmentioning

confidence: 99%

Current Trends in Prepectoral Breast Reconstruction: A Survey of American Society of Plastic Surgeons Members

Marks

Farmer

Afifi

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Prepectoral implant-based breast reconstruction has recently gained increasing popularity, but there are limited data regarding national trends in the use of this technique. Our aim was to determine practice patterns related to prepectoral breast reconstruction among plastic surgeons, as well as to identify perceived advantages and disadvantages of this technique. Methods: A 16-question electronic survey tool was distributed to 2535 members of the American Society of Plastic Surgeons. Survey items focused on surgeon practices related to prepectoral reconstruction, in addition to their motivations for and concerns with performing the procedure. Results: A total of 274 responses were received (10.8% response rate). Nearly half of respondents (48.4%) reported using prepectoral techniques in all or most of their procedures. Decreased animation deformity was identified as the most significant advantage by 76.3% of respondents. Increased rippling and potential wound healing complications were identified as the most significant disadvantages to the procedure by 49.1% and 40.4% of respondents, respectively. The majority of surgeons reported using acellular dermal matrices in their procedures, with most surgeons demonstrating preferences for cohesive and shaped devices. Conclusions: Prepectoral breast reconstruction is being widely adopted by plastic surgeons, with the majority of surgeons in our sample using prepectoral techniques in their practices. Responses demonstrate that this technique offers several perceived advantages, most notably the avoidance of animation deformity. However, our data also highlight that there are still many unanswered questions in the community about the complication profile and technical aspects of prepectoral techniques that warrant further investigation.

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Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women

Cited by 54 publications

References 48 publications

Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction

Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction

Immediate Breast Reconstruction Using the Goldilocks Procedure: A Balance between More Surgery and Patient Satisfaction

Current Trends in Prepectoral Breast Reconstruction: A Survey of American Society of Plastic Surgeons Members

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