Tissue Expander–Based Breast Reconstruction in the Prepectoral Versus Subpectoral Plane

Abstract

Background Breast reconstruction is becoming an increasingly important and accessible component of breast cancer care. We hypothesize that prepectoral patients benefit from lower short-term complications and shorter periods to second-stage reconstruction compared with individuals receiving reconstruction in the subpectoral plane. Methods An institutional review board–approved retrospective review of all adult postmastectomy patients receiving tissue expanders (TEs) was completed for a 21-month period (n = 286). Results A total of 286 patients underwent mastectomy followed by TE placement, with 59.1% receiving prepectoral TEs and 40.9% receiving subpectoral TEs. Participants receiving prepectoral TEs required fewer clinic visits before definitive reconstruction (6.4 vs 8.8, P <0.01) and underwent definitive reconstruction 71.6 days earlier than individuals with subpectoral TE placement (170.8 vs 242.4 days, P < 0.01). Anesthesia time was significantly less for prepectoral TE placement, whether bilateral (68.0 less minutes, P < 0.01) or unilateral (20.7 minutes less, P < 0.01). Operating room charges were higher in the prepectoral subgroup ($31,276.8 vs $22,231.8, P < 0.01). Partial necrosis rates were higher in the prepectoral group (21.7% vs 10.9%, P < 0.01). Conclusions Patients undergoing breast reconstruction using prepectoral TE-based reconstruction benefit from less anesthesia time, fewer postoprative clinic visits, and shorter time to definitive reconstruction, at the compromise of higher operating room charges.

Implant-based Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis

“…We included eight studies (one RCT, 11 and seven NRCSs reported in eight articles 15 , 16 , 18 , 24 , 28 , 29 , 38 , 39 ) that compared prepectoral, partial submuscular, and total submuscular planes of implant placement in 1555 patients. We rated the RCT as having a moderate risk of bias, six of the seven NRCSs at a high risk, and one NRCS at a moderate risk.…”

“…Surgical Complications : Two NRCSs (Nealon et al 37 and Kraenzlin et al 29 ) reported comparable risks of infections. ( See table 4-6, Supplemental Digital Content 4, http://links.lww.com/PRSGO/B953 .)…”

“…( See table 4-6, Supplemental Digital Content 4, http://links.lww.com/PRSGO/B953 .) Nealon et al 37 reported an imprecise adjOR of 0.31 (95% CI <0.01–8.65) and Kraenzlin et al 29 reported a P value of 0.21 (no adjusted effect size reported).…”

“…and Kraenzlin et al29 ) reported comparable risks of infections. (See et al37 reported an imprecise adjOR of 0.31 (95% CI <0.01-8.65) and Kraenzlin et al29 reported a P value of 0.21 (no adjusted effect size reported).…”

Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis

“…We found 13 studies (reported in 15 articles 43,45,51,96,[240][241][242][243][244][245][246][247][248][249][250] ) that conducted randomized or adjusted analyses for the comparison of different flap types among women undergoing AR. An additional six studies (reported in 15 articles 41,42,47,50,63,78,80,83,84,87,90,91,[251][252][253] ) did not report any adjusted effect sizes or P values and are thus not discussed further in this section. Appendix Tables C-7, D-1, D-2, and D-3 describe all 19 studies, irrespective of whether they reported adjusted effect sizes.…”